A site to transform Pubmed publications into these bibliographic reference formats: ADS, BibTeX, EndNote, ISI used by the Web of Knowledge, RIS, MEDLINE, Microsoft's Word 2007 XML.

Sydney Corbiere - Top 30 Publications

Direct Comparison of Four Very Early Rule-Out Strategies for Acute Myocardial Infarction Using High-Sensitivity Cardiac Troponin I.

Background -Four strategies for very early rule-out of acute myocardial infarction (AMI) using high-sensitivity cardiac troponin I (hs-cTnI) have been identified. It remains unclear which strategy is most attractive for clinical application. Methods -We prospectively enrolled unselected patients presenting to the emergency department (ED) with symptoms suggestive of AMI. The final diagnosis was adjudicated by two independent cardiologists. Hs-cTnI levels were measured at presentation and after 1h in a blinded fashion. We directly compared all four hs-cTnI-based rule-out strategies: limit of detection (LOD, hs-cTnI<2ng/L), single cut-off (hs-cTnI<5ng/L), 1h-algorithm (hs-cTnI<5ng/L and 1h-change<2ng/L), and the 0/1h algorithm recommended in the European Society of Cardiology (ESC) guideline combining LOD and 1h-algorithm. Results -Among 2828 enrolled patients, AMI was the final diagnosis in 451 (16%) patients. The LOD approach ruled-out 453 patients (16%) with a sensitivity of 100% (95% CI, 99.2-100%), the single cut-off 1516 patients (54%) with a sensitivity of 97.1% (95% CI, 95.1-98.3%), the 1h-algorithm 1459 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8-99.2%), and the 0/1h algorithm 1463 patients (52%) with a sensitivity of 98.4% (95% CI, 96.8-99.2%). Predefined subgroup analysis in early presenters (≤2h) revealed significantly lower sensitivity (94.2%, interaction p=0.03) of the single cut-off, but not the other strategies. Two-year survival was 100% with LOD and 98.1% with the other strategies (p<0.01 for LOD vs. each of the other strategies). Conclusions -All four rule-out strategies balance effectiveness and safety equally well. The single cut-off should not be applied in early presenters, while the three other strategies seem to perform well also in this challenging subgroup. Clinical Trial Registration - Identifier: NCT00470587.

Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin.

The early diagnosis of acute myocardial infarction (AMI) in patients with mild elevations of high-sensitivity cardiac troponin (hs-cTn) is a challenge. It is unclear whether copeptin, a marker of endogenous stress, or 1h-hs-cTn changes are better suited to address this important unmet clinical need.

Incremental Value of Preoperative Copeptin for Predicting Myocardial Injury.

Copeptin, a novel marker of endogenous stress, has shown diagnostic and prognostic value in nonsurgical patients with a suspected coronary event. We aimed to assess the incremental value of copeptin in addition to established preoperative risk indices to predict the occurrence of postoperative myocardial injury.

Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke.

We compared outcome and complications in patients with stroke treated with intravenous thrombolysis (IVT) who could not live alone without help of another person before stroke (dependent patients) versus independent ones.