International journal of cardiology
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Persons with a clinically recognized myocardial infarction are at increased risk for atrial fibrillation. However a large proportion of all myocardial infarctions remain clinically unrecognized. Whether subjects with electrocardiographic signs of an unrecognized myocardial infarction are also at an increased risk of developing atrial fibrillation is unknown. The objective of this study was to investigate whether unrecognized myocardial infarction was associated with an increased risk of atrial fibrillation in a prospective population-based cohort study. ⋯ The presence of an unrecognized myocardial infarction is associated with a twofold increased risk of atrial fibrillation in men, independent of known cardiovascular risk factors.
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Cardiac troponins are diagnostic markers in acute coronary syndrome and prognostic markers in stable coronary disease. Small increases are occasionally observed in patients with non-cardiac disease, but the prevalence and prognostic value of increased troponin in the general hospitalized population are unknown. ⋯ More than half of the hospitalized patients had hs-TnT levels above the 99(th) percentile. Elevated hs-TnT is a strong mortality risk marker in general hospitalized older patients.
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Multicenter Study Clinical Trial Observational Study
Identifying patients for early discharge: performance of decision rules among patients with acute chest pain.
The HEART score and North American Chest Pain Rule (NACPR) are decision rules designed to identify acute chest pain patients for early discharge without stress testing or cardiac imaging. This study compares the clinical utility of these decision rules combined with serial troponin determinations. ⋯ The HEART score with 0 and 3 hour serial troponin measures identifies a substantial number of patients for early discharge while maintaining high sensitivity for ACS.
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Multicenter Study
β-blocker use in patients after percutaneous coronary interventions: one size fits all? Worse outcomes in patients without myocardial infarction or heart failure.
The influence of β-blocker therapy on prognosis in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) has not been fully explored. ⋯ β-blocker therapy was associated with worse 3-year clinical outcomes in CAD patients who underwent PCI but had no history of MI or HF. Randomized trials are warranted to identify appropriate subsets of patients who could truly benefit from long-term use of β-blockers in this setting.
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Multicenter Study Clinical Trial Observational Study
Mid-regional pro-adrenomedullin in the early evaluation of acute chest pain patients.
The purpose of this study was to investigate the utility of mid-regional pro-adrenomedullin (MR-proADM) in the early diagnosis and risk stratification of patients with acute chest pain in comparison with established and novel biomarkers and risk scores. ⋯ While MR-proADM does not have clinical utility in the early diagnosis of AMI or predicting cardiovascular events in patients with acute chest pain, it may provide prognostic value for all-cause mortality.