coronary disease, acute coronary syndrome, myocardial infarction
DISEASE INTERVENTION COMPARISON RESULTS
Am J Cardiol. 2013 Jun 15;111(12):1701-7 Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
high-sensitive cardiac troponin, increased cutoff at 40-50 ng/L in older patients and renal failure
As Diagnostic Tool
Is better Than
standard cutoff at 14 ng/L
To better diagnose acute coronary syndrome: sensitivity 87% and specificity 87% at 50 ng/Lfor older patients
J Am Coll Cardiol. 2010 May 11;55(19):2096-106 Cohorts
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
copeptin, added to troponin
As Diagnostic Tool
Is better Than
troponin
To more accurately diagnose an acute coronary syndrome (c-statistics 0.93 copeptin + troponin VS 0.84 troponin alone) and to rule out coronary syndrome in the first 3 hours: 92% negative predictive value with copeptin + troponin
Cochrane Database Syst Rev. 2011;1:CD007038 Systematic Review, Cochrane Review
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
pentasacharide analogues, fondaparinux
As Treatment, Acute
Is better Than
low molecular weight heparins (LMWH), enoxaparin
To reduce the risk of all-cause mortality at 90 to 180 days (RR 0.89) while reducing minor bleeding
Ann Intern Med. 2005 Aug 16;143(4):241-50 Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin
As Treatment, Chronic
Is better Than
aspirin alone, NOT compared to aspirin plus clopidrogel
To decrease the annual rate of myocardial infarction (0.022 vs. 0.041) and ischemic stroke (0.004 vs. 0.008) but not to reduce mortality. Major bleeding increased (0.015 vs. 0.006)
Eur Heart J. 2011 Jun;32(11):1379-89 Diagnostic
IN coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
high-sensitive cardiac troponin assays
As Diagnostic Tool
Is better Than
standard cardiac troponin assay
To diagnose acute myocardial infarction: AUC 0.95 sensitive troponine VS 0.90 standard troponine. Best cut-offs in elderly patients differed clearly from younguer patients. Mild elevations are commont in non-infarctus elderly (20% patients)
Eur Heart J. 2013 Sep 11. [Epub ahead of print] Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction, ST-segment elevation The Use of
intracoronary bone marrow cell therapy
As Treatment, Acute
Is better Than
placebo or no cell therapy
To improve (at a time not well defined) left ventricle ejection fraction (LVEF) : 2.5% mean increase, 5.3% when LVEF was < 40%
N Engl J Med. 1998 Nov 5;339(19):1349-57 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome, myocardial infarction, unstable angina, normal cholesterol The Use of
statins, pravastatin 40 mg/d
As Prevention, Secondary
Is better Than
placebo
To reduce - at 6 years - overall mortality (11.0% in pravastatin vs 14.1% in placebo) and cardiovascular mortality (7.3% in pravastatin vs 9.6% in placebo)
Eur Heart J. 2013 Jun 4. [Epub ahead of print] Cohorts
IN dementia, alzheimer, coronary disease, acute coronary syndrome, myocardial infarction, older patients The Use of
cholinesterase inhibitors
As Treatment, Chronic
Is better Than
no cholinesterase inhibitors
To reduce the risk of myocardial infarction (HR 0.62) and death (HR 0.64). Patients taking the highest doses recommended had the lowest risk of MI or death