Cardiac troponins are the preferred biomarkers for diagnosing myocardial infarction (MI). High-sensitivity troponin T (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis of infarction. We assessed the prognostic utility of admission hs-TnT to detect outcomes after primary angioplasty for ST-elevation/new left bundle branch block myocardial infarction (STEMI). Patients admitted to Auckland City Hospital for acute coronary catheterization with a diagnosis of STEMI between October 2010 and September 2011 were identified, and included if hs-TnT levels were measured at admission. Clinical characteristics and major adverse cardiovascular events (MACE: death, myocardial infarction and revascularization) at 30 days and 1 year were collected from national statistics and electronic medical records. Median admission hs-TnT level in the 173 STEMI patients studied was 59 ng/L (interquartile range (IQR) 19–310). Incidences of MACE at 30 days and 1 year were 10% (n=17) and 18% (n=31), respectively. C-statistics and 95% confidence interval (CI) (95% CI) for hs-TnT on admission at detecting MACE at 30 days and 1 year were 0.800 (0.696–0.904) and 0.750 (0.655–0.845) respectively, with the optimal cut-point of 225 ng/L giving sensitivities/specificities of 76.5%/75.6% and 64.5%/78.2% respectively. Admission log(hs-TnT) independently predicted both MACE at 30 days with hazards ratio 5.16, 95% CI (2.25–11.9) and 1 year with hazards ratio 2.88, 95% CI (1.79–4.63), as did age and cardiogenic shock. Age, Maori or Pacific ethnicity and chronic respiratory disease were independent predictors of hs-TnT>225 ng/L. Admission hs-TnT measured in primary angioplasty is strongly prognostic of MACE at 30 days and 1 year, even following adjustment for potential confounding variables.
To explore effect of early intermittently closing drainage tube on blood loss control after total knee arthroplasty.Totally 60 total knee replacement patients were randomly divided into experimental group and control group according to the different drainage ways of postoperative from January 2014 to January 2015. There were 30 patients in experimental group, including 12 males and 18 females, aged from 58 to 76 years old with an average of (67.0±6.7) years old, preoperative Hb was(128.82±8.29) g/L; drainage tubes were intermittently opened for 10 minutes every 2 hours, and kept opened until 6 h after operation. There were 30 patients in control group, including 13 males and 17 females; aged from 60 to 79 years old with an average of(69.0±7.2) years old; Preoperative Hb was(126.55±8.49) g/L; tubes were kept open with negative pressure before its removing. Blood loss in operation, postoperative drainage, total blood loss, hidden blood loss, allogenic blood transfusion and local wounds during hospitalization were observed and compared.Postoperative drainage and total blood loss in experimental group was(184±56) ml, (1 014±258) ml; and significantly lower than that of control group(476±98)ml, (1 390±383) ml(P<0.05); there were no statistical differences in interoperation blood loss and hidden blood loss(P>0.05). The incisions between two groups were healed at stage I without infection. The size of limb swelling and the number of the cases with ecchymosis in experimental group was (3.8±0.9) cm and 10 respectively; control group was (3.4±0.7) cm and 8, while there were no significant differences between two groups(P>0.05). Five patients in experimental group were performed blood transfusion, 13 patients in control group were performed blood transfusion, and with differences between two groups(P<0.05).Intermittently closing of drainage tube after 6 h of TKA could reduce the amount of drainage, total blood loss and blood transfusion rate, and not aggravate limb swelling and subcutaneous ecchymosed. It is proved to be an effective measure to reduce bleeding after TKA.
To the Editor: The bound of healthy dietary sodium and the risk rising in high dietary sodium have generated much controversy. The current standing is that higher prevalence of cardiovascular disease (CVD) is associated with higher sodium intake.1-3 Two studies published in the New England Journal of Medicine (NEJM) have also confirmed this perception.4, 5 Mozaffarian and colleagues suggested that 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g/d.4 However, the PURE study published in NEJM argued that increased CVD mortality and morbidity were observed in the patients whose urinary sodium excretion was <3.0 g/d.6 At the same time, these studies confirmed the association of lower dietary potassium with both increased blood pressure and adverse health outcomes5, 6 The unusual results of the Prospective Urban Rural Epidemiological (PURE) study6 also attracted the attention of Chinese doctors, especially the results that a sodium intake <3 g/d leads to an increase of 0.1 mm Hg/g in diastolic blood pressure. We have been reviewing and summarizing the Chinese data from 1980 until now. Large-scale, typical, or influential reports were selected from the reference data from the China National Knowledge Infrastructure and PubMed database (Table). Most of the trials showed that dietary salt or sodium excretion was positively correlated with blood pressure or CVD risk, regardless of the region, rural or urban. The range of high salt was 6 g/d to 10 g/d in the Chinese participants. Meanwhile, some data showed that different ethnic groups have different tolerance to high salt. Although the data were based more on epidemiological survey and questionnaires and less on intervention observations, more on point urine samples and less on urine samples collected over a 24-hour period, and more on single centers and less on multiple centers, the results still suggest that higher salt intake (>6 g/d) results in higher prevalence of hypertension and CVD. Some academic associations have also questioned the results of the PURE study. The American Heart Association criticized the PURE publication in NEJM and indicated that the publication has methodological weaknesses, such as reverse causality, wherein people eat less salt because of their illness rather than lowering salt consumption to avoid illness (American Heart Association, http://newsroom.heart.org/news/excessive-sodium-consumption-has-dire-impact-on-global-health-new-study-finds). Studies based on weak methodologies are likely to continue to generate controversy, and the science will only be advanced by carefully conducting rigorous research (Canadian Institute for Health Research and Heart and Stroke Foundation Chair in Hypertension Prevention and Control: http://www.hypertensiontalk.com/science-of-salt-weekly/). What's more, the World Hypertension League (WHL) and many other organizations have confirmed and expanded the associations between excess dietary sodium and human diseases. Many of these studies have utilized more rigorous scientific methods than the PURE study but are published in journals with lower scientific impact and publicity than NEJM. WHL is committed to the regular reviews of the literature, the setting of minimum standards for research methods, and the regular updates to dietary recommendations. China has the largest number of hypertensive patients and the Chinese people have very high sodium consumption. Chinese doctors, researchers, patients, and medical insurance policy makers should have consistent voice in sodium management. We should evaluate any study with a balanced view. The PURE study has declared limitations in validated method, probability-sampling approach, and observational studies. We suggest further studies and deliberation before setting up the guides for healthy dietary sodium intake.
Objective Catheter ablation is an important treatment for ventricular tachycardia (VT) that reduces the frequency of episodes of VT. We sought to evaluate the cost-effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy. Methods A decision-analytic Markov model was used to calculate the costs and health outcomes of catheter ablation or AAD treatment of VT for a hypothetical cohort of patients with ischaemic cardiomyopathy and an implantable cardioverter-defibrillator. The health states and input parameters of the model were informed by patient-reported health-related quality of life (HRQL) data using randomised clinical trial (RCT)-level evidence wherever possible. Costs were calculated from a 2018 UK perspective. Results Catheter ablation versus AAD therapy had an incremental cost-effectiveness ratio (ICER) of £144 150 (€161 448) per quality-adjusted life-year gained, over a 5-year time horizon. This ICER was driven by small differences in patient-reported HRQL between AAD therapy and catheter ablation. However, only three of six RCTs had measured patient-reported HRQL, and when this was done, it was assessed infrequently. Using probabilistic sensitivity analyses, the likelihood of catheter ablation being cost-effective was only 11%, assuming a willingness-to-pay threshold of £30 000 used by the UK’s National Institute for Health and Care Excellence. Conclusion Catheter ablation of VT is unlikely to be cost-effective compared with AAD therapy based on the current randomised trial evidence. However, better designed studies incorporating detailed and more frequent quality of life assessments are needed to provide more robust and informed cost-effectiveness analyses.
Abstract Randomised controlled trials (RCTs) are the gold standard study design used to evaluate the safety and effectiveness of healthcare interventions. The reporting quality of RCTs is of fundamental importance for readers to appropriately analyse and understand the design and results of studies which are often labelled as practice changing papers. The aim of this article is to assess the reporting standards of a representative sample of randomised controlled trials (RCTs) published between 2019 and 2020 in four of the highest impact factor general medical journals. A systematic review of the electronic database Medline was conducted. Eligible RCTs included those published in the New England Journal of Medicine , Lancet , Journal of the American Medical Association , and British Medical Journal between January 1, 2019, and June 9, 2020. The study protocol was registered on medRxiv ( https://doi.org/10.1101/2020.07.06.20147074 ). Of a total eligible sample of 497 studies, 50 full-text RCTs were reviewed against the CONSORT 2010 statement and relevant extensions where necessary. The mean adherence to the CONSORT checklist was 90% (SD 9%). There were specific items on the CONSORT checklist which had recurring suboptimal adherence, including in title (item 1a, 70% adherence), randomisation (items 9 and 10, 56% and 30% adherence) and outcomes and estimation (item 17b, 62% adherence). Amongst a sample of RCTs published in four of the highest impact factor general medical journals, there was good overall adherence to the CONSORT 2010 statement. However there remains significant room for improvement in areas such as description of allocation concealment and implementation of randomisation.
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