Impact of the CHADS-VASc score on late clinical outcomes in patients undergoing left atrial appendage occlusion.

Background: Left atrial appendage occlusion (LAAO) is an accepted strategy for cardioembolic events prevention in patients with non-valvular atrial fibrillation (AF) unsuitable for anticoagulation. However, uncertainties persist regarding the benefit of LAAO in highly-comorbid patients. The aim of this study was to assess the impact of the CHADS-VASc score beyond thromboembolic risk in predicting clinical outcomes in patients undergoing LAAO.

Performance of the Micra cardiac pacemaker in nonagenarians.

Introduction And Objectives: The Micra transcatheter pacing system has shown high effectiveness and a lower complication rate than conventional transvenous pacemakers. However, the benefit of the device is unknown in the very old population (≥ 90 years). The aim of this study was to evaluate the safety and effectiveness of Micra in patients ≥ 90 years.

Using Food Models to Enhance Sugar Literacy among Older Adolescents: Evaluation of a Brief Experiential Nutrition Education Intervention.

Adolescent diets high in sugar are a public health concern. Sugar literacy interventions have changed intake but focused more on children, adults, and early adolescents and on sugar sweetened beverages rather than total sugar consumption. Food models are an efficacious experiential learning strategy with children.

[Combined high-sensitivity copeptin and troponin T evaluation for the diagnosis of non-ST elevation acute coronary syndrome in the emergency department].

Objectives: To assess the diagnostic yield of a high-sensitivity copeptin (hs-copep) assay alone or in combination with a high-sensitivity cardiac troponin T (hs-cTnt) assay for the diagnosis of non-ST segment elevation acute coronary syndrome (NSTEMI) in patients with chest pain in the emergency department (ED). The secondary aim was to assess the 1-year prognostic utility of these biomarkers in this clinical context.

Material And Methods: Retrospective observational study of a series of patients attended for chest pain suggesting myocardial ischemia in 5 Spanish ED.

Feasibility and safety of an early discharge strategy after low-risk acute myocardial infarction treated with primary percutaneous coronary intervention: the EDAMI pilot trial.

Objectives: This pilot trial evaluated the feasibility and safety of an early discharge strategy (EDS: ≤72 h, followed by outpatient lifestyle interventions), in comparison with a conventional discharge strategy (CDS) for low-risk (Zwolle risk score ≤3) ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty.

Methods: One hundred patients were randomized to an EDS (n = 54) or a CDS (n = 46). The primary end point was the feasibility of the EDS: (1) ≥70% of EDS patients discharged ≤72 h, (2) ≥70% visited by a nurse ≤7 days after discharge, (3) ≥70% with ≥3 visits by the nurse and (4) ≥70% visited by a cardiologist ≤3 months.

Antiphospholipid syndrome and acute myocardial infarction: treatment with thrombectomy and abciximab.

Antiphospholipid syndrome (APS) is an autoimmune coagulation disorder that manifests clinically as venous and arterial thrombosis, and may affect any tissue or organ. Coronary artery involvement, however, is very rare. Case reports in the literature describing patients with coronary acute syndrome and APS treated with coronary angioplasty show conflicting results.

Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS.

Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days.

Using high-sensitivity troponin T: the importance of the proper gold standard.

Objective: The study objective was to determine how best to use high-sensitivity cardiac troponin T (hscTnT) to diagnose myocardial infarction.

Methods: A total of 358 patients presenting with acute coronary syndromes sampled at admission and 2, 4, and 6 to 8 hours. Both contemporary cardiac troponin T (cTnT) and hscTnT were measured.

Transfusion strategies for acute upper gastrointestinal bleeding.

Background: The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.

Methods: We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter).

New York Heart Association class versus amino-terminal pro-B type natriuretic peptide for acute heart failure prognosis.

Background: The prognostic value of the New York Heart Association classification (NYHAC) in acutely decompensated heart failure (ADHF) is unknown.

Objectives: We sought to determine the relative value of NYHAC among patients with concomitantly measured amino-terminal pro-B type natriuretic peptide (NT-proBNP) at presentation with ADHF.

Materials And Methods: NYHAC was determined for 720 patients with ADHF and 1-year mortality status was examined.

[III Catalan registry of ST elevation acute myocardial infarction. Comparison with former Catalan registries I and II from Catalonia, Spain].

Background And Objective: To analyze the use of reperfusion therapy in patients with ST elevation myocardial infarction (STEMI) in Catalonia in a registry performed in 2006 (IAM CAT III) and its comparison with 2 previous registries

Patients And Methods: Frequency of reperfusion therapy and time intervals between symptom onset - reperfusion therapy were the principal variables investigated. The IAM CAT I (June-December 2000) included 1,450 patients, the IAM CAT II (October 2002-April 2003) 1,386, and the IAM CAT III (October-December 2006) 367.

Results: The proportion of patients treated with reperfusion increased progressively (72%, 79% and 81%) as the use of primary angioplasty (5%, 10% and 33%).

New electrocardiographic diagnostic criteria for the pathologic R waves in leads V1 and V2 of anatomically lateral myocardial infarction.

Aims: To study the different QRS patterns in leads V1 and V2 in first inferior, lateral, and combined inferolateral myocardial infarction (MI) to recognize which are the ECG criteria that best define the presence of lesions isolated to the anatomically lateral wall of the left ventricle.

Methods And Results: We studied consecutive patients with first inferior (15), lateral (9), or inferolateral (21) MI with reference to contrast enhanced cardiac magnetic resonance (CE-CRM). We measured the R-wave amplitude and duration, the R/S ratio, and the T-wave amplitude and polarity in leads V1 and V2.

Blood pressure is not associated with haematoma enlargement in acute intracerebral haemorrhage.

Background And Purpose: We performed an observational study that compared baseline and subsequent blood pressure (BP) measurements and its association with haematoma enlargement (HE) in patients with intracerebral haemorrhage (ICH).

Methods: We prospectively studied consecutive patients with supratentorial spontaneous ICH within the first 6 h after the onset of symptoms. HE was defined as an increase >or=33% in the volume of haematoma on the CT obtained 24-48 h after the onset of symptoms as compared with the CT at admission.

Effect of body mass index on diagnostic and prognostic usefulness of amino-terminal pro-brain natriuretic peptide in patients with acute dyspnea.

Background: Amino (N)-terminal pro-brain natriuretic peptide (NT-proBNP) testing is useful for diagnostic and prognostic evaluation in patients with dyspnea. An inverse relationship between body mass index (BMI); (calculated as weight in kilograms divided by height in meters squared) and NT-proBNP concentrations has been described.

Methods: One thousand one hundred three patients presenting to the emergency department with acute dyspnea underwent analysis.

NT-ProBNP reduction percentage during admission for acutely decompensated heart failure predicts long-term cardiovascular mortality.

Background: N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied.

[Hemosiderin-laden macrophages count in sputum in diagnosis of dyspnea of heart origin].

Background And Objective: The respiratory or heart origin of dyspnea is not always easy to find out using the available diagnostic tools. Many patients present both heart and lung diseases that cause dyspnea. The role of hemosiderin-laden macrophages count (HC) in sputum in this context has not been well settled so far.

N-terminal pro-brain natriuretic peptide reflects pulmonary capillary leakage in patients with acute dyspnea.

Natriuretic peptides have proved useful in the diagnosis of heart failure in patients presenting to the emergency department with shortness of breath. Dyspnea and orthopnea in heart failure are clinical expressions of pulmonary capillary congestion and leakage, which may be assessed by the percentage of pulmonary hemosiderin-laden macrophages (HLM) in induced sputum. We found a significant difference in the percentage of HLM present in sputum among patients with acute heart failure, patients with noncardiac dyspnea with ventricular dysfunction, and patients without heart failure (p = 0.

Evaluation of patients with suspected acute coronary syndromes in the emergency department.

Patients complaining of chest pain (CP) who visit the emergency department (ED) represent the second cause of consultation in this department, and 20-30% of hospital admissions for medical reasons. These patients form a somewhat heterogeneous group with many different aetiologies and degrees of severity. In this setting, the clinical objectives include the prompt identification of patients with acute coronary syndromes (ACSs), the prompt evaluation of the immediate risk (i.

D-Dimer is an early diagnostic marker of coronary ischemia in patients with chest pain.

Background: Chest pain is a frequent symptom in the emergency department and often presents a diagnostic challenge. Because coronary thrombosis is a hallmark of acute ischemic syndromes, the substrates of the coagulation and fibrinolysis cascades may be markers of coronary ischemia. The objective of this study was to determine the diagnostic value of several hemostatic markers in patients presenting to the emergency department (ED) with chest pain syndromes.