Is High-Sensitivity Troponin Actually Helping Us?
Spoon Feed
This RCT of U.S. patients being evaluated for acute MI using a 0/1 hour hs-cTnI protocol, compared to standard care with a 0/3 hour hs-cTnI protocol, didn’t find a difference in the percentage of patients discharged from the ED nor in the rates of 30 day death or MI.
Source
Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial. Ann Emerg Med. 2024 Jun 15:S0196-0644(24)00235-X. doi: 10.1016/j.annemergmed.2024.04.024. Epub ahead of print. PMID: 38888531.
Re-DOSE VF… DSED for Shock-Refractory VF?
Spoon Feed
This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks.
Source
The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial. Resuscitation. 2024 May;198:110186. doi: 10.1016/j.resuscitation.2024.110186. Epub 2024 Mar 24. PMID: 38522736.
The Ultimate Chest Pain Pathway? Not Quite
Spoon Feed
This was a validation study for the recently published American College of Cardiology (ACC) Expert Consensus Decision Pathway for chest pain. Results suggest this pathway is safe and efficacious for use in patients without known CAD; however, performance was not as good for patients with known CAD.
Source
Validation of the ACC Expert Consensus Decision Pathway for Patients With Chest Pain. J Am Coll Cardiol. 2024 Apr 2;83(13):1181-1190. doi: 10.1016/j.jacc.2024.02.004. Epub 2024 Mar 25. PMID: 38538196.
Point | Counterpoint – Adenosine First-Line for SVT?
Spoon Feed
Adenosine is an effective, rapid onset, short acting atrioventricular (AV) nodal blocker that can be used as a diagnostic aid for regular narrow and wide complex tachycardias and for definitive management for supraventricular tachycardia (SVT). It should remain first-line over calcium channel blockers (CCB) for SVT.
Source
Adenosine Should be First-Line Treatment for Supraventricular Tachycardia. Annals of Emergency Medicine. Published December 19, 2023. doi: 10.1016/j.annemergmed.2023.10.017
Point | Counterpoint – Calcium Channel Blockers First-Line for SVT?
Spoon Feed
Nondihydropyridine calcium channel blockers (CCB) are an efficacious option to treat supraventricular tachycardia (SVT) and do not cause the sense of doom that adenosine imparts. When taking into account CCB contraindications, diltiazem and verapamil could be first-line options for SVT.
Source
Calcium Channel Blockers Versus Adenosine for Paroxysmal Supraventricular Tachycardia. Annals of Emergency Medicine. 2024;83:394-395. https://doi.org/10.1016/j.annemergmed.2023.09.003
Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations
Spoon Feed
A significant minority of code STEMI patients have an initial normal computer ECG interpretation. Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation.
Source
Emergency department Code STEMI patients with initial electrocardiogram labeled "normal" by computer interpretation: A 7-year retrospective review. Acad Emerg Med. 2024 Mar;31(3):296-300. doi: 10.1111/acem.14795. Epub 2023 Sep 17. PMID: 37620163.
Continued Controversy Between Contrast and Kidneys
Spoon Feed
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.
Source
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
What Are the New Duke ISCVID Criteria?
Spoon Feed
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.
Source
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.
Should We Use New Duke Criteria for Infective Endocarditis?
Spoon Feed
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.
New AHA Statement on Cardiac Cath Lab Activation After OHCA
Spoon Feed
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.
Source
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.