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Acute kidney injury (AKI) is a common complication following acute myocardial infarction (AMI) and associated with worse outcomes. Serum Potassium levels (K, mEq/L), which are regulated by the kidneys, are related with poor prognosis in patients with AMI.

To evaluate whether K levels predict imminent AKI in patients with AMI.

This retrospective nested case-control study was based on medical records of hospitalized AMI patients, 2002-2012. The cases (AKI group) were defined as an increase of ≥1.5-fold in serum creatinine level or a decrease of ≥25% in the estimated glomerular filtration rate (eGFR) during the hospitalization. The control group comprised of matched randomly selected patients that did not develop AKI. For both groups, all creatinine and K levels were obtained for up-to 72h prior to the AKI diagnosis (index time).

A total of 12,498/17,678 admissions met the inclusion criteria. The AKI and the control groups consisted of 430 and 1345 matched admission respectively. K levels, prior AKI diagnosis seemed to be higher in the AKI group. Multivariate analysis showed that K≥4.5 within 36-56h prior to the index time was an independent predictor of the subsequent AKI, OR=2.3, p<.001. The c-statistic of the model was 0.859, p<.001. Predictivity of K for AKI was stronger among ST-elevation (STEMI) vs. Non-ST-elevation AMI (NSTEMI) patients (OR=4, p<.001 vs. 1.7, p=.025 respectively; p-for-interaction=0.038).

K≥4.5 is an independent and incremental marker of imminent AKI in patients with AMI, predictivity is stronger in patients with STEMI than NSTEMI.
K ≥ 4.5 is an independent and incremental marker of imminent AKI in patients with AMI, predictivity is stronger in patients with STEMI than NSTEMI.
The method to perform a precise mapping of non-pulmonary vein (PV) triggers has not been fully investigated. The purpose of this study was to assess the efficacy of self-reference mapping for eliminating non-PV triggers in a large series of patients including the long-term outcomes.

Among 446 atrial fibrillation (AF) ablation procedures in 431 patients at 2 institutions, we prospectively enrolled patients who had reproducible non-PV triggers. Non-PV triggers from the left atrial posterior wall (LAPW) and superior vena cava (SVC) were excluded. Ablation procedure and long-term clinical outcomes were evaluated. The origin of non-PV triggers were detected using a self-reference mapping technique, which does not require any other reference catheters. Instead of using signals obtained from a fixed intracardiac catheter as the reference, an operator repeatedly moved a multi-electrode catheter to the earliest site creating a new reference each time to map the non-PV trigger.

A total of 32 non-PV triggers excluding origins from the LAPW and SVC were induced in 23 patients. All triggers were mapped using a self-reference mapping technique with 11.0±10.2min and eliminated by radiofrequency ablation with 10.7±10.0 points application. No major complications were observed. During the follow-up (529±270days), 18 patients (77%) were free from atrial tachyarrhythmias after a 3-month blanking period. Three patients received additional ablation procedures. No non-PV triggers ablated during the previous procedure were observed.

A novel self-reference mapping technique is useful for eliminating non-PV triggers for the short- and long-term outcomes.
A novel self-reference mapping technique is useful for eliminating non-PV triggers for the short- and long-term outcomes.
We aimed to assess the use of enhanced stent visualisation (ESV) on outcomes, after PCI with overlapping stents, specifically using CLEARstent technology.

Stent underexpansion and overlap are both significant risk factors for restenosis and stent thrombosis. Enhanced stent visualisation (e.g. CLEARstent) systems could provide important data to reduce under-expansion and stent overlap.

This was a cohort study based on this institution's percutaneous coronary intervention (PCI) registry. A total of 2614 patients who had PCI for stable angina or acute coronary syndromes (ACS, excluding cardiogenic shock) with overlapping 2nd generation drug eluting stents (DES) in the same vessel between May 2015 and January 2018 were included in the analysis. Patients were divided into ESV (n=1354) and no ESV guided intervention (n=1260). The primary end-point was major adverse cardiovascular events (MACE target vessel revascularisation, target vessel myocardial infarction and all-cause mortality) recorded at a median follow up of 2.4years.

Groups were comparable for patient characteristics (age, diabetes mellitus, ACS presentation). A significant difference in MACE was observed between patients who underwent ESV-guided PCI (9.5%) compared with patients who underwent Standard PCI (14.4%, p=.018). This difference was mainly driven by reduced rates of target vessel revascularisation and recurrent myocardial infarction. Overall this difference persisted after multivariate Cox analysis (HR 0.86, 95% CI 0.73-0.98) and propensity matching (HR=0.88, 95% CI 0.69-0.99).

We suggest that routine clinical use of ESV technology during PCI can be useful, and is associated with better medium-term angiographic and clinical outcomes. Further study is required to build on this promising signal.
We suggest that routine clinical use of ESV technology during PCI can be useful, and is associated with better medium-term angiographic and clinical outcomes. Further study is required to build on this promising signal.
Dapagliflozin is an antidiabetic medication that has been shown to reduce the risk of heart failure hospitalization and cardiovascular death in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to determine the cost-utility of add-on dapagliflozin treatment for HFrEF.

An analytical decision model was constructed to assess lifetime costs and outcomes from a healthcare system perspective. The cohort comprised HFrEF patients with left ventricular ejection fraction (LVEF) ≤40%, and New York Heart Association (NYHA) class II-IV with an average age of 65years. SR10221 molecular weight Clinical inputs were derived from the results of the Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure (DAPA-HF) trial. Risk of non-cardiovascular death data, readmission rate data, and treatment-related cost data were based on Thai population. The outcomes and costs were discounted at 3% annually. A series of sensitivity analyses were also conducted.

The increased cost of dapagliflozin add-on treatment from 17,442 THB (559 USD) to 54,405 THB (1745 USD) was associated with a QALY gain from 6.
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