July 2, 2020

Background: In patients presenting to the ED with acute coronary syndrome (ACS), dual antiplatelet therapy is the current standard treatment.  This typically consists of aspirin and an adenosine diphosphate receptor antagonist.  It is fairly well understood that prasugrel and ticagrelor provide greater, and more rapid platelet inhibition than clopidogrel (i.e. Plavix) [5][6]. Both ticagrelor and prasurgel have a class I recommendation for use in ACS with or without ST-segment elevation. The loading strategies of these two medications are different: ticagrelor is administered as a pre-treatment medication prior to diagnostic angiography while prasugrel is given after coronary anatomy has been assessed by angiography (No advantage has been observed when prasugrel is used as pretreatment) [7].  The authors of this trial (ISAR-REACT 5) looked to compare ticagrelor vs prasugrel in patients with ACS to evaluate efficacy and safety.

May 6, 2020

There continues to be a slew of publications coming out on a near daily basis in regard to COVID-19.  Some publications will deserve their own posts and others can really be summarized in one or two paragraphs.  In this post I will summarize 5 papers published in the past week, that I found interesting and each has a unique, but important message.  None of these papers are very long, but there are some important aspects of each I felt tied into each other from a cardiovascular standpoint.

April 27, 2020

Background: In patients with stable coronary artery disease the goals of treatment are to reduce the risk of death, ischemic events, and to improve quality of life. In order to achieve those objectives all patients with coronary artery disease should be treated with guideline based medical therapy. Currently, many of them undergo elective angiography and placement of stents if needed when they have abnormal stress tests. Before the widespread use of drug-eluting stents, trials evaluating incremental effects of revascularization added to medical therapy did not show a reduction in the rates of death or MI. However, those trials did not include sufficient numbers of participants, and only included those with known coronary anatomy prior to randomization.

REBEL Review 100: Canadian Syncope Risk Score

Created April 25, 2020 | Cardiovascular | DOWNLOAD

April 20, 2020

Background Information: The presentation of a patient with syncope to the Emergency Department (ED) can pose a challenge to clinicians as the identification of a serious underlying condition is the priority. Often the original cause of the syncope is difficult to determine in the ED and ultimately results in unnecessary hospitalization. Of all syncope patients evaluated in the ED, 3-5% of them will be found to have a serious condition after ED disposition.1 Furthermore, the literature has shown that hospital admissions due to syncope were associated with low mortality or the need for procedures.2 Emergency physicians are then also posed with the task of determining which patients may be considered low, medium and high risk for a serious outcome. Several risk stratification tools have been developed to help with the identification of these patients, however many of these tools are not validated and very complex, therefore they are not used clinically. The Canadian Syncope Risk Score (CSRS) is among these decision tools, however it has yet to be validated. The authors of this paper sought to conduct a multicenter ED based prospective study to validate this tool and advocate its superior use over some of the other risk stratification tools that currently exist.
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