2011 November 22

Comparison of Role of Early (Less Than Six Hours) to Later (More Than Six Hours) or No Cardiac Catheterization After Resuscitation From Out-of-Hospital Cardiac Arrest.

Nov 222011

Comparison of Role of Early (Less Than Six Hours) to Later (More Than Six Hours) or No Cardiac Catheterization After Resuscitation From Out-of-Hospital Cardiac Arrest.

Am J Cardiol. 2011 Nov 17;

Authors: Strote JA, Maynard C, Olsufka M, Nichol G, Copass MK, Cobb LA, Kim F

Abstract
Despite reports of patients with resuscitated sudden cardiac arrest (rSCA) receiving acute cardiac catheterization, the efficacy of this strategy is largely unknown. We hypothesized that acute cardiac catheterization of patients with rSCA would improve survival to hospital discharge. A retrospective cohort of 240 patients with out-of-hospital rSCA caused by ventricular tachycardia or fibrillation was identified from 11 institutions in Seattle, Washington from 1999 through 2002. Patients were grouped into those receiving acute catheterization within 6 hours (?6-hour group, n = 61) and those with deferred catheterization at >6 hours or no catheterization during the index hospitalization (>6-hour group, n = 179). Attention was directed to survival to hospital discharge, neurologic status, extent of coronary artery disease, presenting electrocardiographic findings, and symptoms before arrest. Propensity-score methods were used to adjust for the likelihood of receiving acute catheterization. Survival was greater in patients who underwent acute catheterization (72% in the ?6-hour group vs 49% in the >6-hour group, p = 0.001). Percutaneous coronary intervention was performed in 38 of 61 patients (62%) in the ?6-hour group and 13 of 170 patients (7%) in the >6-hour group (p <0.0001). Neurologic status was similar in the 2 groups. A significantly larger percentage of patients in the acute catheterization group had symptoms before cardiac arrest and had ST-segment elevation on electrocardiogram after resuscitation. Age, bystander cardiopulmonary resuscitation, daytime presentation, history of percutaneous coronary intervention or stroke, and acute ST-segment elevation were positively associated with receiving cardiac catheterization. In conclusion, in this series of patients who sustained out-of-hospital cardiac arrest, acute catheterization (<6 hours of presentation) was associated with improved survival.

PMID: 22100026 [PubMed - as supplied by publisher]

Link to Article at PubMed

Prognostic Value of Uric Acid in Patients With ST-Elevated Myocardial Infarction Undergoing Primary Coronary Intervention.

Am J Cardiol Start a Discussion »

Nov 222011

Prognostic Value of Uric Acid in Patients With ST-Elevated Myocardial Infarction Undergoing Primary Coronary Intervention.

Am J Cardiol. 2011 Nov 17;

Authors: Kaya MG, Uyarel H, Akpek M, Kalay N, Ergelen M, Ayhan E, Isik T, Cicek G, Elcik D, Sahin O, Cosgun SM, Oguzhan A, Eren M, Gibson CM

Abstract
Elevated uric acid (UA) levels have been associated with cardiovascular disease in epidemiologic studies. The relation between UA levels and long-term outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention is not known. Data from 2,249 consecutive patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were evaluated. Patients were divided into 2 groups with high or low UA using upper limits of normal of 6 mg/dl for women and 7 mg/dl for men. There were 1,643 patients in the low-UA group (mean age 55.9 ± 11.6 years, 85% men) and 606 patients in the high-UA group (mean age 60.5 ± 12.6 years, 76% men). Serum UA levels were 8.0 ± 1.5 mg/dl in the high-UA group and 5.2 ± 1.0 mg/dl in the low-UA group (p <0.001). The in-hospital mortality rate was significantly higher in patients with high UA levels (9% vs 2%, p <0.001), as was the rate of adverse outcomes in patients with high UA. The mean follow-up time was 24.3 months. Cardiovascular mortality, reinfarction, target vessel revascularization, heart failure, and major adverse cardiac events were all significantly higher in the high-UA group. In a multivariate analyses, high plasma UA levels were an independent predictor of major adverse cardiac events in the hospital (odds ratio 2.03, 95% confidence interval 1.25 to 3.75, p = 0.006) and during long-term follow-up (odds ratio 1.64, 95% confidence interval 1.05 to 2.56, p = 0.03). In conclusion, high UA levels on admission are independently associated with in-hospital and long-term adverse outcomes in patients with ST-segment elevation myocardial infarction who undergo primary percutaneous coronary intervention.

PMID: 22100027 [PubMed - as supplied by publisher]

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High-Dose Daptomycin for Cardiac Implantable Electronic Device-Related Infective Endocarditis.

Clin Infect Dis Start a Discussion »

Nov 222011

High-Dose Daptomycin for Cardiac Implantable Electronic Device-Related Infective Endocarditis.

Clin Infect Dis. 2011 Nov 18;

Authors: Durante-Mangoni E, Casillo R, Bernardo M, Caianiello C, Mattucci I, Pinto D, Agrusta F, Caprioli R, Albisinni R, Ragone E, Utili R

Abstract
Background.?Cardiac implantable electronic device (CIED)-related endocarditis is a growing challenge because of increasing incidence and significant mortality. Current treatment is based on complete hardware removal coupled with long-term administration of effective and safe antimicrobials. Daptomycin at the dose of 6 mg/kg/day has been found to be effective in staphylococcal endocarditis, but limited data exist on CIED endocarditis. Moreover, whether higher doses could be more effective but equally safe in this setting is currently unknown.Methods.?We report here our experience with high-dose daptomycin in the treatment of 25 cases of CIED endocarditis due to staphylococci.Results.?Patients were mostly elderly and male, with large lead vegetations and severe comorbidities. Pathogens were Staphylococcus epidermidis (56%), Staphylococcus aureus (28%), and other coagulase-negative staphylococci (16%). Only 4 patients (16%) had a normal pretreatment renal function. The median daptomycin daily dose was 8.3 mg/kg (range, 6.4-10.7). Daptomycin was administered for a median of 20 days (range, 8-52). Percutaneous lead extraction was performed in 88% of patients. Two patients (8%) failed to clear bacteremia. The overall clinical success of treatment was 80%, whereas a complete microbiological success was observed in 92% of patients. Creatine phosphokinase values were monitored and increased above normal in 5 cases (20%). No serious adverse event related to high-dose daptomycin was observed and no patient required discontinuation because of muscle toxicity.Conclusions.?Our experience suggests that high-dose daptomycin may be a safe therapeutic option in staphylococcal CIED endocarditis and may be associated with high microbiological responses and clinical success.

PMID: 22100575 [PubMed - as supplied by publisher]

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Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations.

Radiol Clin North Am Start a Discussion »

Nov 222011

Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations.

Radiol Clin North Am. 2012 Jan;50(1):137-47

Authors: Anderson SW, Soto JA

Abstract
This article discusses the critical protocol considerations in imaging patients with abdominal pain in the emergency department, specifically, the use of oral contrast, intravenous contrast, image postprocessing, and radiation dose. These considerations related to the use of computed tomography imaging of abdominal pain are reviewed in an evidence-based fashion.

PMID: 22099492 [PubMed - in process]

Link to Article at PubMed

Prevalence of validated risk factors for developing atrial fibrillation-can we identify high-risk ED patients?

Am J Emerg Med Start a Discussion »

Nov 222011

Prevalence of validated risk factors for developing atrial fibrillation-can we identify high-risk ED patients?

Am J Emerg Med. 2011 Nov 17;

Authors: Barrett TW, Couch SA, Jenkins CA, Storrow AB

Abstract
OBJECTIVE: The aim of this study was to investigate whether emergency department (ED) patients who were newly diagnosed with atrial fibrillation (AF) displayed risk factors for incident AF on prior ED visits. METHODS: This was a secondary analysis of a retrospective cohort study of ED patients with symptomatic AF at a tertiary referral center. We selected patients who were newly diagnosed with AF between July 1, 2005, and August 31, 2008, and had at least 1 ED visit before their diagnosis. We calculated the Framingham Heart Study AF risk score for each visit by documenting the presence of the risk factors (age, sex, body mass index, systolic blood pressure, hypertension treatment, PR interval, and ages of clinically significant cardiac murmur and heart failure diagnosis). RESULTS: Of the 296 patients newly diagnosed with AF, 115 (39%) had at least 1 prior ED visit resulting in 454 ED visits for analysis. The median time from first to last visit was 4 years (interquartile range [IQR], 2.1-5.9). The median age was 66 years (IQR, 49-79 years). Home medications included antihypertensives in 81% of visits, and 60% of visits with available electrocardiograms had a PR interval of 160 milliseconds or more. Heart failure history was reported in 23% of visits. The median AF risk score was 8 (IQR, 4-10) corresponding to a 16% 10-year predicted risk. CONCLUSIONS: Nearly 40% of patients diagnosed with new AF had previous ED visits and displayed validated risk factors for incident AF. The ED provides an opportunity to identify and educate these patients as well as refer them for primary prevention interventions.

PMID: 22100470 [PubMed - as supplied by publisher]

Link to Article at PubMed

November 2011
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