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Cardiothoracic - The Royal Wolverhampton NHS Trust Library Service

GLUTAMICS- A Randomized

Clinical Trial on Glutamate Infusion

in 861 patients Undergoing

Surgery for Acute Coronary

Syndrome

Glutamate has been claimed to protect the

heart from ischemia and to facilitate metabolic

and hemodynamic recovery after ischemia.

The GLUTAmate for Metabolic Intervention in

Coronary Surgery trial investigated whether an

intravenous glutamate infusion given in

association with surgery for acute coronary

syndrome could reduce mortality and prevent

or mitigate myocardial injury and postoperative

heart failure. Source: BMJ Evidence Updates.

Reference

Vidlund M et al (2012) GLUTAMICS-a

randomized clinical trial on glutamate infusion

in 861 patients undergoing surgery for acute

coronary syndrome. The Journal of Thoracic

and Cardiovascular Surgery. Published ahead

of print 19 th June 2012.

Link to full text article, an Athens password

is required to access this item.

High-Sensitivity Cardiac Troponin in

the Distinction of Acute Myocardial

Infarction from Acute Cardiac

Noncoronary Artery Disease

The study hypothesized that high-sensitivity

cardiac troponin (hs-cTn) and its early change

are useful in distinguishing acute myocardial

infarction (AMI) from acute cardiac

noncoronary artery disease.

The combined use of hs-cTn at presentation

and its early absolute change excellently

discriminates between patients with AMI and

those with cardiac noncoronary artery disease.

Source: BMJ Evidence Updates.

Reference

Haaf P et al. (2012) High-sensitivity cardiac

troponin in the distinction of acute myocardial

infarction from acute cardiac noncoronary

artery disease. Circulation, 126 (1), pp. 31-40.

Link to full text article, an Athens password

is required to access this item.

6

Costs and Cost-Effectiveness of

Carotid Stenting Versus

Endarterectomy for Patients at

Standard Surgical Risk

The Carotid Revascularization Endarterectomy

versus Stenting Trial (CREST) demonstrated

similar rates of the primary composite end

point between carotid artery stenting (CAS)

and carotid endarterectomy (CEA), although

the risk of stroke was higher with CAS, and the

risk of myocardial infarction was higher with

CEA. Given the large number of patients who

are candidates for these procedures, an

understanding of their relative cost and costeffectiveness

may have important implications

for health care policy and treatment guidelines.

If the CREST results can be replicated in

clinical practice, the findings suggested in this

trial suggest that factors other than costeffectiveness

should be considered when

deciding between treatment options for carotid

artery stenosis in patients at standard risk for

surgical complications. Source: BMJ Evidence

Updates.

Reference

Vilain KR (2012) Costs and cost-effectiveness

of carotid stenting versus endarterectomy for

Patients at Standard Surgical Risk: results

from the arotid revascularization

endarterectomy versus stenting trial (CREST).

Stroke. 43 (9), pp. 2408-2416.

Full text available via inter library loan, there is

a charge for this service.

One-Hour Rule-out and Rule-in of

Acute Myocardial Infarction Using

High-Sensitivity Cardiac Troponin T

High-sensitivity cardiac troponin (hs-cTn)

assays seem to improve the early diagnosis of

acute myocardial infarction (AMI), but it is

unknown how to best use them in clinical

practice. Our objective was to develop and

validate an algorithm for rapid rule-out and

rule-in of AMI.

Using a simple algorithm incorporating hscTnT

baseline values and absolute changes

within the first hour allowed a safe rule-out as

well as an accurate rule-in of AMI within 1 hour

in 77% of unselected patients with acute chest

pain. This novel strategy may obviate the need

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