Circulation. 2006;114:1555
(Circulation. 2006;114:1555.)
© 2006 American Heart Association, Inc.
Issue Highlights
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IMPLICATIONS OF THE FAILURE TO IDENTIFY HIGH-RISK ELECTROCARDIOGRAM FINDINGS FOR THE QUALITY OF CARE OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: RESULTS OF THE EMERGENCY DEPARTMENT QUALITY IN MYOCARDIAL INFARCTION (EDQMI) STUDY, by Masoudi et al.
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The appropriate diagnosis and treatment of patients with an
acute myocardial infarction depends largely on the correct interpretation
of the electrocardiogram in the emergency department. Despite
the importance of the skill of correctly interpreting the electrocardiogram,
relatively little is known about the prevalence of misinterpretations
and their consequences. This retrospective study by Masoudi
et al examined the failure to identify high-risk electrocardiographic
findings in patients presenting to 1 of 5 emergency departments
in California and Colorado. The authors report the failure to
identify important ST-segment depressions, elevations or T-wave
inversions on the first electrocardiogram of patients with a
confirmed acute myocardial infarction. They also investigated
the association of the misinterpretations with the quality of
patient care and in-hospital mortality. The present study identifies
an important opportunity for us to improve care. See p
1565.
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DRAWBACKS AND PROGNOSTIC VALUE OF FORMULAS ESTIMATING RENAL FUNCTION IN PATIENTS WITH CHRONIC HEART FAILURE AND SYSTOLIC DYSFUNCTION, by Smilde et al.
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The adverse prognostic impact of impaired renal function has
been well demonstrated across the entire spectrum of cardiovascular
diseases. In this issue of
Circulation, Smilde and colleagues
performed a detailed comparison of the 2 widely-used creatinine-based
estimates of renal function (Cockcroft-Gault and Modification
of Diet in Renal Disease equations) with the much more difficult
to perform "gold standard" iothalamate clearance, in patients
with chronic heart failure and reduced left ventricular ejection
fraction. Although subtle differences were observed between
these assessments of renal function, each provided important
prognostic information regarding subsequent cardiovascular outcomes.
See p
1572.
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HIGH SERUM C-REACTIVE PROTEIN LEVEL IS NOT AN INDEPENDENT PREDICTOR FOR STROKE: THE ROTTERDAM STUDY, by Bos et al.
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Increasingly, C-reactive protein (CRP) is recommended for cardiovascular
risk prediction. Major adverse events in subjects at risk or
in patients with cardiovascular disease not only include acute
coronary syndromes and sudden death, but also stroke. The 2
clinical entities differ considerably, however, and stroke itself
is heterogenous and includes ischemic as well as hemorrhagic
stroke. Thus, predictive markers for stroke or acute coronary
syndromes may differ. Bos et al used the Rotterdam cohort of
over 6000 subjects without previous stroke to address this issue.
During a follow-up period of more than 8 years, almost 500 strokes
occurred. High CRP levels were associated with the risk of any
stroke and of ischemic strokes. However, CRP did not improve
stroke risk prediction as assessed by the Framingham score,
age, or sex. Thus, it appears that the clinical utility of CRP
for stroke prediction above and beyond simple clinical parameters
is quite limited. It is possible that CRP might reflect the
degree of inflammation that is caused by the risk factors of
a given patient, but CRP, by itself, does not add predictive
value. Nevertheless, vascular inflammation may still be involved
in the development of cerebrovascular disease. See p
1591.
Visit http://circ.ahajournals.org:
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Cardiology Patient Page
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The Metabolic Syndrome. See p
e528.
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Images in Cardiovascular Medicine
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Cough Cardiopulmonary Resuscitation Revisited. See p
e530.
Case of Anomalous Right Superior Vena Cava. See p e532.
Hiccups and Dysphonic Metallic Voice: A Unique Presentation of Twiddler Syndrome. See p e534.
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Correspondence
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See p
e536.
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Letter by Nieminen et al Regarding Article, "Differential Impact of Blood Pressure-Lowering Drugs on Central Aortic Pressure and Clinical Outcomes: Principal Results of the Conduit Artery Function Evaluation (CAFE) Study"
- Tuomo Nieminen, Mika Kähönen, and Tiit Kööbi
Circulation 2006 114: e536.
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Drawbacks and Prognostic Value of Formulas Estimating Renal Function in Patients With Chronic Heart Failure and Systolic Dysfunction
- Tom D.J. Smilde, Dirk J. van Veldhuisen, Gerjan Navis, Adriaan A. Voors, and Hans L. Hillege
Circulation 2006 114: 1572-1580.
[Abstract]
[Full Text]
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High Serum C-Reactive Protein Level Is Not an Independent Predictor for Stroke: The Rotterdam Study
- Michiel J. Bos, C. Maarten A. Schipper, Peter J. Koudstaal, Jacqueline C.M. Witteman, Albert Hofman, and Monique M.B. Breteler
Circulation 2006 114: 1591-1598.
[Abstract]
[Full Text]
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Implications of the Failure to Identify High-Risk Electrocardiogram Findings for the Quality of Care of Patients With Acute Myocardial Infarction: Results of the Emergency Department Quality in Myocardial Infarction (EDQMI) Study
- Frederick A. Masoudi, David J. Magid, David R. Vinson, Albert J. Tricomi, Ella E. Lyons, Laurie Crounse, P. Michael Ho, Pamela N. Peterson, John S. Rumsfeld for the Emergency Department Quality in Myocardial Infarction (EDQMI) Study Investigators
Circulation 2006 114: 1565-1571.
[Abstract]
[Full Text]
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