European heart journal. Acute cardiovascular care
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Eur Heart J Acute Cardiovasc Care · Oct 2015
Randomized Controlled TrialPrognostic performance of a high-sensitivity assay for cardiac troponin I after non-ST elevation acute coronary syndrome: Analysis from MERLIN-TIMI 36.
Newer troponin assays offer the ability to quantify circulating troponin levels at an order of magnitude lower than contemporary assays, fueling continued debate over the prognostic implications of very low-level increases in concentration. We evaluated the prognostic implications of low-level increases in cardiac troponin I (cTnI) using an investigational single-molecule high-sensitivity assay in patients with acute coronary syndrome (ACS). ⋯ Low-level cardiac troponin detected using a single-molecule technique, below the cutpoint of a contemporary sensitive assay, identified a significant gradient of risk. These findings support the prognostic relevance of low-level cardiac troponin elevation with increasingly sensitive assays in patients with ACS.
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Eur Heart J Acute Cardiovasc Care · Oct 2015
Use of copeptin in emergency patients with cardiac chief complaints.
Combined testing of copeptin and troponin at presentation to the emergency department (ED) has been shown to possess a high negative predictive value (NPV) for ruling out acute myocardial infarction (AMI) in patients with suspected acute coronary syndrome. ⋯ Copeptin seems to be a promising biomarker for the initial evaluation of emergency patients with cardiac chief complaints. The study adds to the evidence that a single copeptin and troponin test at admission achieves a high NPV for ruling-out NSTEMI early in low-to-intermediate risk patients and thus--in combination with the clinical evaluation--seems to be of considerable relevance in emergency medicine.
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Eur Heart J Acute Cardiovasc Care · Oct 2015
Multicenter Study Observational StudyContemporary antithrombotic strategies in patients with acute coronary syndrome admitted to cardiac care units in Italy: The EYESHOT Study.
Several new antithrombotic therapies have emerged for the treatment of acute coronary syndrome (ACS). We sought to assess contemporary patterns of antithrombotic therapies use in patients with ACS. ⋯ The EYESHOT registry shows the current pattern of antithrombotic treatments for ACS patients admitted to Italian CCUs and provides insights which may help to improve the clinical care of such patients.
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Eur Heart J Acute Cardiovasc Care · Oct 2015
First-in-man analysis of the i-cor assist device in patients with cardiogenic shock.
In patients with refractory cardiogenic shock (CS) mechanical assistance by venous-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy may be considered to reach haemodynamic stabilization. In this first-in-man study, we analysed the applicability of the new i-cor VA-ECMO assist device equipped with a diagonal pump system. ⋯ This first-in-man analysis suggests that the i-cor ECMO device is successfully applicable in humans. The data set the stage for further evaluation of this novel system and provide the necessary basis to design randomised evaluations.
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Eur Heart J Acute Cardiovasc Care · Oct 2015
High sensitivity-troponin elevation secondary to non-coronary diagnoses and death and recurrent myocardial infarction: An examination against criteria of causality.
Myonecrosis provoked by illness unrelated to unstable coronary plaque is common, but uncertainty about a cause-effect relationship with future events challenges the appropriateness of initiating therapies known to be effective in cardiac conditions. We examined the causal relationship between troponin elevation in non-coronary diagnoses and late cardiac events using the Bradford Hills criteria for causality. ⋯ Consistency with causal criteria between secondary myonecrosis and cardiac events suggest the potential benefit for extending cardiac specific interventions to this population if supported in trials appropriately designed to address competing risks. Troponin elevation precipitated by non-coronary events is common and demonstrates an associations with late mortality that are analogous to spontaneous MI resulting from unstable coronary plaque. These observations help inform the design of randomized clinical trials exploring the benefits and risk of therapies with established benefits in other cardiac conditions. Such studies will need to appropriately account for competing risks in this population of patients.