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In patients with ACS and concern for STEMI/NSTEMI requiring urgent intervention, randomization to the contrast volume reduction (CVR) group reduced the rate of acute kidney injury (AKI) and sustained kidney damage.

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Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2024;83(11):1059-1069. doi:10.1016/j.jacc.2024.01.016

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Yesterday, we covered an article demonstrating the superior diagnostic accuracy of the new Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (Duke-ISCVID) criteria. Today, we cover what the new criteria actually are.

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The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023 Aug 22;77(4):518-526. doi: 10.1093/cid/ciad271. Erratum in: Clin Infect Dis. 2023 Oct 13;77(8):1222.

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This external validation compared the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (ISCVID) Criteria against various other criteria for diagnosing infective endocarditis (IE) and found the 2023 Duke-ISCVID Criteria had the best test characteristics. Tomorrow, we'll dive into the new criteria.

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The goal of invasive management in the cardiac catheterization laboratory (CCL) is to identify and treat culprit coronary lesion or additional resuscitative measures (such as mechanical circulatory support (MCS) or interventions for massive pulmonary embolism). This is a scientific statement from the American Heart Association (AHA) which provides an update on the role of CCL in the management of resuscitated patients or those with ongoing cardiac arrest.

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Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2024 Jan 30;149(5):e274-e295. doi: 10.1161/CIR.0000000000001199. Epub 2023 Dec 19. PMID: 38112086.

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This summary of clinical guideline updates for the diagnosis and management of aortic diseases includes recommendation changes surrounding the importance of multidisciplinary care teams and referral to centers with higher case volumes when feasible for potentially better outcomes, transthoracic echocardiogram (TTE) at time of transthoracic aortic aneurysm (TAA), and updated aneurysm size recommendations for repair, to name a few. Keep reading for more details!

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Diagnosis and Management of Aortic Diseases. JAMA. 2023 Dec 21;331(4):352-353. doi: 10.1001/jama.2023.23668.

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In this large multicenter observational cohort study, 0.3% of patients presenting with potential acute aortic syndrome (AAS) symptoms ended up having AAS. Clinician gestalt outperformed the available clinical decision rules (CDRs).

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Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024;41(3):136-144. Published 2024 Feb 20. 

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An artificial intelligence (AI) ECG model outperformed standard STEMI criteria in identifying occlusion myocardial infarction (OMI) confirmed by coronary angiography.

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International evaluation of an artificial intelligence–powered electrocardiogram model detecting acute coronary occlusion myocardial infarction, European Heart Journal - Digital Health, 2023. https://doi.org/10.1093/ehjdh/ztad074

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This single-center prospective study found that in 2,275 ECGs with a computerized interpretation of “normal” and “otherwise normal,” there was a negative predictive value (NPV) of 100% for STEMI, with no final diagnoses of ACS or STEMI, and none required cardiac catheterization that visit.

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Validity of Computer-interpreted "Normal" and "Otherwise Normal" ECG in Emergency Department Triage Patients. West J Emerg Med. 2024;25(1):3-8. doi:10.5811/westjem.58464

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In out-of-hospital cardiac arrest (OHCA) patients with refractory ventricular fibrillation (RVF), there was an association with short-interval (<75ms) dual sequential external defibrillation (DSED) and higher probability of termination of ventricular fibrillation (VF) and return of spontaneous circulation (ROSC) compared with longer DSED intervals.

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The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest. Resuscitation. 2024 Jan;194:110082. doi: 10.1016/j.resuscitation.2023.110082. Epub 2023 Dec 11.

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This article outlines the updated 2023 guidelines for diagnosis and management of atrial fibrillation. Continue reading for ways to incorporate them into your emergency medicine practice.