Discharge timing and outcomes after uncomplicated non-ST-segment elevation acute myocardial infarction.

Background: Length of stay after non-ST-segment elevation myocardial infarction (NSTEMI) continues to decrease, but information to guide duration of hospitalization is limited.

Methods: We used landmark analyses, in which the landmark defined potential days of discharge, to estimate complication rates on the first day the patient would have been out of the hospital, and estimated associations between timing of discharge and 30-day and 1-year event-free survival after discharge among NSTEMI patients.

Results: Among 20,410 NSTEMI patients, median length of stay was 7 (4, 12) days; 3,209 (15.

Mechanical circulatory support for right ventricular failure.

Objectives: The aim of this study was to explore the clinical utility of a commercially available centrifugal flow pump as a centrifugal flow-right ventricular support device (CF-RVSD) in patients with right ventricular failure (RVF).

Background: RVF is associated with high in-hospital mortality. Limited data regarding efficacy of the CF-RVSD for RVF exist.

Sinus arrest following angioplasty and stenting for superior vena cava syndrome.

Superior vena cava (SVC) syndrome is a complication resulting from long-term residence of leads or in-dwelling catheters at the SVC to right atrial (RA) junction. SVC syndrome management is complicated by variable responses to anticoagulation therapies and technically challenging interventional procedures, such as balloon dilatation or stent placement at the SVC-RA junction to relieve blood-flow obstruction. Potential complications resulting from angioplasty/stenting for SVC syndrome are serious and include stent migration, major bleeding, and embolism.

Emphasizing statin safety in the hospitalized patient: a review.

This review examines the safe use of statin therapy in the hospitalized patient. Available data support initiation of statin therapy during hospitalization in patients with acute coronary syndromes or established cardiovascular disease and in high-risk patients with diabetes mellitus and chronic kidney disease (except for those on maintenance hemodialysis). Because of the increased risk of cardiovascular disease, statins are given to solid-organ transplant survivors and those treated with protease inhibitors for human immunodeficiency virus.

Eptifibatide-induced thrombocytopenia: with thrombosis and disseminated intravascular coagulation immediately after left main coronary artery percutaneous coronary angioplasty.

Early clinical trials of eptifibatide did not show a significant association between eptifibatide and the development of thrombocytopenia, thrombosis, or disseminated intravascular coagulation. However, more recent literature has suggested a significant association between eptifibatide and the development of thrombocytopenia and thrombosis. Although the true incidence and the pathophysiology of these associations are unknown, the development of these events can be life-threatening.

Clinical experience and patient outcomes associated with the TandemHeart percutaneous transseptal assist device among a heterogeneous patient population.

There is a paucity of literature describing the outcomes associated with the use of TandemHeart percutaneous ventricular assist device (PVAD). The literature is limited by analyzing only subsets of patients. We present the clinical outcomes and safety associated with the use of TandemHeart among a series of heterogeneous patients requiring PVAD support.

Leveraging time and learning style, iPod vs. realtime attendance at a series of medicine residents conferences: a randomised controlled trial.

Objective: To determine whether participation in educational conferences utilising iPod technology enhances both medical knowledge and accessibility to educational content among medical residents in training.

Design/measurements: In May 2007, the authors led a randomised controlled study involving 30 internal medicine residents who volunteered either to attend five midday educational conferences or to use an iPod audio/video recording of the same conferences, each followed by a five-question competency quiz. Primary outcomes included quantitative assessment of knowledge acquisition and qualitative assessment of resident perception of ease of use.

Personal digital assistants: a review of current and potential utilization among medical residents.

Background: Increases in the daily work load of medical residents, coupled with constraints on their work hours have made personal digital assistants (PDAs) an increasingly popular management resource. No comprehensive review of PDA utilization among medical residents has been published.

Purpose: The purpose is to review and analyze current literature addressing PDA use by medical residents and to asses the future impact handheld computers may have on the daily practices of residents.

An interesting case of positional hypoxia: the effect of multiple synergistic pathological conditions.

This report describes an elderly patient evaluated for generalized fatigue, dyspnea, presyncopal episodes, and positional hypoxemia. Workup revealed posturally related oxygen desaturation, a patent foramen ovale (PFO), an atrial septal aneurysm, and primary adrenal insufficiency. Normal intracardiac pressures and a right-to-left PFO shunt were present only while the patient was in the upright position.

Platelet inhibitors: what are the data in women?

Cardiovascular disease is the leading cause of disability and mortality among women in the United States. However, relative to their representation among the overall population of patients presenting with acute coronary syndromes, women have been underrepresented in clinical trials of treatment strategies for acute coronary syndromes. In general, subgroup analyses and meta-analyses of the data from the major treatment trials have demonstrated similar treatment effects among women and men, but questions recently have been raised regarding the role and effect of antiplatelet therapy in the treatment of women.

The influence of low (81 mg) versus high (325 mg) doses of ASA on the incidence of sirolimus-eluting stent thrombosis.

Background: Conflicting opinion exists regarding the optimal dose of acetyl salicylic acid (ASA) to be given after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We sought to evaluate the influence of ASA dose on the incidence of unexplained subacute and late stent thrombosis in the era of DES.

Methods: We performed a retrospective analysis of the incidence of subacute and late stent thrombosis in our patient population over a 2-year period.