Does giving prasugrel before angiography help patients with non-ST-elevation acute coronary syndromes? This 2014 appraisal of ACCOAST examines the balance between ischaemic outcomes and major bleeding, alongside patient selection, the composite endpoint and the limits of applying the findings more widely.
JC. ACS: Antiplatelets ACCOAST-ed? Read More
Could online estimates of pre-test probability help clinicians choose investigations for pulmonary embolism and acute coronary syndromes? This initial 2013 discussion examines a trial of web-based decision support, exploring radiation exposure, gaps in the calculator’s data and unanswered questions about diagnostic safety.
JC: I’ll just ask Dr Google..for some PE/ACS investigation advice @ St.Emlyn’s Read More
Can one CT scan reliably investigate coronary artery disease, pulmonary embolism and aortic dissection in patients with chest pain? This 2013 review of triple rule-out CT examines diagnostic accuracy, patient selection and reference standards, asking whether the evidence establishes a meaningful benefit for emergency patients.
JC: Triple Rule Out CT – are the rays worth it? St.Emlyn’s Read More
Should patients without ST elevation receive coronary intervention after an out-of-hospital cardiac arrest? This 2013 review explores observational evidence, presenting rhythms, symptoms and ECG findings, while emphasising that associations with survival do not establish a benefit caused by the intervention.
PCI for OOHCA with NSTEMI post ROSC? An acronym too far? Read More
A 2013 journal club reviews Louise Cullen and colleagues’ validation of a two-hour strategy using high-sensitivity troponin to assess chest pain. It explores diagnostic performance, the proportion potentially suitable for early discharge and how patient selection and subsequent interventions complicate interpretation.
JC: Cullen on high sensitivity Troponin. St.Emlyn’s Read More
Simon Carley reviews the 2013 ACC/AHA STEMI guidance from an emergency department perspective. The discussion focuses on access to PCI, cardiac arrest and cardiogenic shock, and the practical challenge of transferring critically ill patients safely to the catheter laboratory.
New STEMI Guidelines. St.Emlyn’s Read More
An elevated troponin result does not tell the whole clinical story. In this 2013 discussion, Rick Body explores high-sensitivity assays, chronic elevations and type 2 myocardial infarction, explaining why serial results need to be interpreted alongside the patient’s presentation.
Why hyper-troponin-aemia does not always equal acute myocardial infarction Read More
Could changing D-dimer thresholds reduce unnecessary CT pulmonary angiography? This 2012 journal club examines a retrospective study, questioning how patients were selected, how risk was assessed and whether small subgroups can support changes to investigation pathways.
JC Are we doing too many CTPAs? St.Emlyn’s Read More
