Cardiology News / Recent Literature Review / Second Quarter 2016
ESC Meeting: Rome, 27-31/8/2016
HCS Panhellenic Congress: Athens, 20-22/10/2016
TCT Conference: Washington, DC, 29/10-2/11/2016
AHA Scientific Sessions: New Orleans, 12-16/11/2016
AF Symposium: Orlando, 12-14/1/2017
ACC.17: Washington, DC, 17-19/3/2017
HONEST Study: Morning Home Blood Pressure (BP) May be Superior to Clinic BP as a Predictor of Coronary Events and Stroke in Patients With Hypertension
In 21,591 hypertensive patients (mean age ~65 years), having 127 stroke and 121 CAD events over a mean follow-up of 2 years, the incidence of stroke events was significantly higher in patients with morning home systolic blood pressure (HSBP) ≥145 mmHg compared with <125 mmHg (hazard ratio -HR ~6.0), and in patients with clinic systolic blood pressure (CSBP) ≥150 mmHg compared with <130 mmHg (HR 5.82); morning HSBP predicted stroke events similarly to CSBP. Incidence of CAD events was significantly higher in patients with morning HSBP ≥145 mmHg compared with <125 mmHg (HR 6.24) and in patients with CSBP ≥160 mmHg compared with <130 mmHg (HR 3.51). Thus, compared with morning HSBP predicted CAD events more strongly than CSBP (Kario K et al, J Am Coll Cardiol 2016;67:1519-1527).
A 1-h Combination Algorithm Allows Fast Rule-Out/ Rule-In of Major Adverse Cardiac Events (MACE): In Patients with Chest Pain Presenting to Emergency Department (ED), Combining hs-cTnT Levels on Arrival and 1 h Later With the Patient History and ECG More Effectively Identified MACE Within 30 Days Than Screening Based on hs-cTnT Alone
In a prospective observational study enrolling 1,038 patients presenting to the emergency department (ED) with chest pain, an extended algorithm comprising hs-cTnT results at 1 h combined with history and ECG, identified 60% of all patients for rule-out and had a higher sensitivity than the troponin algorithm alone (97.5% vs 87.6%; p< 0.001). The negative predictive value was 99.5% and the likelihood ratio was 0.04 with the extended algorithm vs 97.8% and 0.17, respectively, with the troponin algorithm. The extended algorithm ruled-in 14% of patients with a higher sensitivity (75.2% vs 56.2%; p< 0.001) but a slightly lower specificity (94.0% vs 96.4%; p< 0.001) than the troponin algorithm. The rule-in arms of both algorithms had a likelihood ratio >10 (Mokhtari A et al, J Am Coll Cardiol 2016;67:1531-1540)... (excerpt)
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