Circulation 2015

Treatment


1. Deye N, Cariou A, Girardie P et al. Endovascular Versus External Targeted Temperature Management for Patients With Out-of-Hospital Cardiac Arrest: A Randomized, Controlled Study. Circulation. 2015 Jul 21;132(3):182-93. doi: 10.1161/CIRCULATIONAHA.114.012805. Epub 2015 Jun 19.

CONCLUSION: Despite better hypothermia induction and maintenance, endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome. PMID: 26092673

Comment: External cooling is just as good as endovascular cooling.  Since cooling is less important than we once thought, invasive strategies to make it happen faster are overkill and unhelpful, according to this study.  External cooling was very low tech in this study, consisting of, " fans, a homemade tent, and ice packs."


2. Stub D, Smith K, Bernard S et al. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015 Jun 16;131(24):2143-50. doi: 10.1161/CIRCULATIONAHA.114.014494. Epub 2015 May 22.

CONCLUSION: Supplemental oxygen therapy in patients with ST-elevation-myocardial infarction but without hypoxia may increase early myocardial injury and was associated with larger myocardial infarct size assessed at 6 months. PMID: 26002889

Comment: Use oxygen in STEMI only as needed.  It is not helpful, rather is very harmful if given when not indicated.  The O2 (8L/min) group had greater recurrent MI, arrhythmia, and infarct size.

3. Lilja G, Nielsen N, Friberg H et al. Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C. Circulation. 2015 Apr 14;131(15):1340-9. doi: 10.1161/CIRCULATIONAHA.114.014414.  Epub 2015 Feb 13.

CONCLUSIONS: Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of 33°C and 36°C was targeted. Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment-elevation myocardial infarction not having had a cardiac arrest. PMID: 25681466

Comment: Here is more evidence to suggest that mild cooling is just as good in arrest patients.


4. Fox CS, Bonaca MA, Ryan JJ et al. A randomized trial of social media from Circulation. Circulation. 2015 Jan 6;131(1):28-33. doi: 10.1161/CIRCULATIONAHA.114.013509. Epub 2014 Nov 18.

CONCLUSIONS: A social media strategy for a cardiovascular journal did not increase the number of times an article was viewed. Further research is necessary to understand and quantify the ways in which social media can increase the impact of published cardiovascular research. PMID: 25406308

Comment: When Circulation tried to boost its article views by pushing articles on Facebook and Twitter, it didn't work.  I'm not sure what this means for the new Altmetric number commonly seen alongside articles these days.  Does this mean you can't cook those numbers, that people will organically share on social media what they think is important? I think this is correct.


5. Stiell IG, Brown SP, Nichol G et al. What is the optimal chest compression depth during out-of-hospital cardiac arrest resuscitation of adult patients? Circulation. 2014 Nov 25;130(22):1962-70. doi: 10.1161/CIRCULATIONAHA.114.008671. Epub 2014 Sep 24.

CONCLUSIONS: This large study of out-of-hospital cardiac arrest patients demonstrated that increased cardiopulmonary resuscitation compression depth is strongly associated with better survival. Our adjusted analyses, however, found that maximum survival was in the depth interval of 40.3 to 55.3 mm (peak, 45.6 mm), suggesting that the 2010 American Heart Association cardiopulmonary
resuscitation guideline target [i.e. 50mm] may be too high. PMID: 25252721

Comment: For those of us who still have a hard time thinking in mm, 45.6mm = 1.8 inches.

Diagnostic

1. Schnell F, Riding N, O'Hanlon R et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation. 2015 Jan 13;131(2):165-73. doi: 10.1161/CIRCULATIONAHA.114.011038. Epub 2014 Nov 10.

CONCLUSIONS: Pathologic T-wave inversion (PTWI) should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac
magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression. PMID: 25583053

Comment: What is considered PTWI?  "All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1-V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation."  If you see PTWI, know that 44.5% will have cardiac disease.  Ask about a family history of sudden cardiac death, and refer the patient-athlete to follow up.  Hypertrophic cardiomyopathy was the most common abnormality discovered in follow up.

2. Twerenbold R, Wildi K, Jaeger C et al. Optimal Cutoff Levels of More Sensitive Cardiac Troponin Assays for the Early Diagnosis of Myocardial Infarction in Patients With Renal Dysfunction. Circulation. 2015 Jun 9;131(23):2041-50. doi: 10.1161/CIRCULATIONAHA.114.014245. Epub 2015 May 6.

CONCLUSIONS: More sensitive cTn assays maintain high diagnostic accuracy in patients with renal dysfunction. To ensure the best possible clinical use, assay-specific optimal cutoff levels, which are higher in patients with renal dysfunction, should be considered. PMID: 25948542

Comment: It's hard to know what to do with positive troponin values in patients with renal dysfunction (GFR <60).  This study suggests that sensitive and high-sensitivity troponins retain their diagnostic accuracy but the cut off values should be 2-3 times the baseline cut-off.  Specifically, the authors note, "The optimal receiver-operator characteristic curve-derived cTn cutoff levels in patients with renal dysfunction were significantly higher compared with those in patients with normal renal function (factor, 1.9-3.4)."

Review

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Clinical Prediction Rules

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