We know that cath is beneficial in patients with NSTEMI, but the timing of the intervention is not known. In this RCT of >3000 patients with NSTEMI, they were randomized to early cath (<24 hours, actual mean timing 14 hours) or delayed cath (>36 hours, actual mean timing 50 hours). There was no difference in the primary outcome measure (composite death, MI, CVA at 6 months). However, in subgroup analysis, those at the highest risk (as defined by the GRACE score, abstract), did have better outcomes in the early intervention (abstract). In general, most NSTEMI patients will do just as well with early or delayed cath, other than those at highest GRACE risk score (risk factors including age, CHF, PVD, SBP, creatinine, killip class, cardiac arrest, ST deviation, and elevated biomarkers).
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]
By reading the headlines recently, practitioners would not know if they saved or tanked the healthcare system. One day disaster looms, the next we have moderated growth and business can continue as usual (and by business, I mean doing the correct things correctly). A new study, along with some recent data, helps shed some light […]