European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Aug 2016
Is the pre-hospital ECG after out-of-hospital cardiac arrest accurate for the diagnosis of ST-elevation myocardial infarction?
Current guidelines recommend that comatose out-of-hospital cardiac arrest patients with ST-segment elevations (STEs) following return of spontaneous circulation (ROSC) should be referred for an acute coronary angiography. We sought to investigate the diagnostic value of the pre-hospital ROSC-ECG in predicting ST-elevation myocardial infarction (STEMI). ⋯ The pre-hospital ROSC-ECG is a suboptimal diagnostic tool to predict STEMI and therefore not a sensitive tool for triage to cardiac centres. This supports the incentive of referring all comatose survivors of out-of-hospital cardiac arrest of suspected cardiac origin to a tertiary heart centre with the availability of acute coronary angiography, even in the absence of STEs.
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Eur Heart J Acute Cardiovasc Care · Aug 2016
Long-term outcome of patients after out-of-hospital cardiac arrest in relation to treatment: a single-centre study.
Outcome after out-of-hospital cardiac arrest (OHCA) remains poor. With the introduction of automated external defibrillators, percutaneous coronary intervention (PCI) and mild therapeutic hypothermia (MTH) the prognosis of patients after OHCA appears to be improving. The aim of this study was to evaluate short and long-term outcome among a non-selected population of patients who experienced OHCA and were admitted to a hospital working within a ST elevation myocardial infarction network. ⋯ In this integrated ST elevation myocardial infarction network survival and neurological outcome of selected patients with ROSC after OHCA and treated with PCI was good. There is insufficient evidence about the outcome of this approach, which has a significant impact on utilisation of resources. Good quality randomised controlled trials are needed. In selected patients successfully resuscitated after OHCA of presumed cardiac aetiology, we believe that a more liberal application of primary PCI may be considered in experienced acute cardiac referral centres.
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Eur Heart J Acute Cardiovasc Care · Jun 2016
Comparative StudyLong-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: A prospective cohort study.
We aimed to study in-hospital mortality and long-term survival in elderly compared to younger patients with ST-segment elevation myocardial infarction (STEMI) in the era of primary angioplasty. ⋯ Short-term prognosis was acceptable in very elderly STEMI patients, especially in the invasively treated subgroup. However, only 52% of STEMI patients ⩾80 years were alive after three years of follow-up. Very elderly patients had 2.6 times higher risk of in-hospital mortality and 4.1 times the risk of not surviving during long-term follow-up compared to patients <80 years, after adjustment for confounding factors and selection bias.
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Eur Heart J Acute Cardiovasc Care · Jun 2016
Randomized Controlled TrialFrailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: Insights from the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial.
Little is known regarding consequences of frailty in patients with acute coronary syndrome (ACS). We assessed the associations of frailty and outcomes in ACS patients who were participating in a clinical trial. ⋯ Frailty is associated with the composite of cardiovascular death, MI, or stroke. Frailty assessment contributes to risk prediction and adds to the GRACE score.
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Eur Heart J Acute Cardiovasc Care · Apr 2016
ReviewCall to action: Initiation of multidisciplinary care for acute heart failure begins in the Emergency Department.
The Emergency Department is the first point of healthcare contact for most patients presenting with signs and symptoms of acute heart failure (AHF) and thus, plays a critical role in AHF management. Despite the increasing burden of AHF on healthcare systems in general and Emergency Departments in particular, there is little guidance for implementing care and disease management programmes. This has led to an urgent call for action to prioritize and improve the management of patients with AHF presenting to the Emergency Department. ⋯ Multiple disciplines, including emergency medicine, hospital medicine, cardiology, nephrology and geriatrics, should provide input into the development of a multidisciplinary approach to AHF management in the ED and beyond, including in-hospital treatment, discharge and follow-up. This will ensure consensus of opinion and improve adherence. The benefits of standardized, multidisciplinary care have been shown in other areas of acute and chronic diseases and will also provide benefit for AHF patients presenting to Emergency Departments.