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).
Fill in the Blanks: Q: “The diagnosis of type 2 MI is associated with a _____ prognosis. ___% of patients will live five years after their diagnosis.” The answer is a) POOR and b) a staggering 40%. I did not know that. However, what I am aware of is the ambiguity around Type 2 MIs and […]
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 […]