Search

Introduction: cardiac troponin (cTn) concentrations above the manufacturer recommended upper limit of normal (ULN) are frequently seen in hospital patients without a clinical presentation consistent with type 1 myocardial infarction, and the significance of this is uncertain. The aim of this study was to assess the relationship between medium term mortality and cTn concentration in a large consecutive hospital population, regardless of whether there was a clinical indication for performing the test.Method: this prospective observational study included 20,000 consecutive in-hospital and outpatient patients who had a blood test for any reason at a large teaching hospital, and in whom a hs-cTnI assay was measured, regardless of the original clinical indication. Mortality was obtained via NHS Digital. Results: A total of 20,000 patients were included in the analysis and 18,282 of these (91.4%) did not have a clinical indication for cTnI testing. Overall, 2825 (14.1%) patients died at a median of 809 days. The mortality was significantly higher if the cTnI concentration was above the ULN (45.3% versus 12.3% pConclusion: in a large, unselected hospital population, in 91.4% of whom there was no clinical indication for testing, cTnI concentration was independently associated with medium term cardiovascular and non-cardiovascular mortality in the statistical model tested.

BACKGROUND: Patients hospitalized with COVID-19 suffer thrombotic complications. Risk factors for poor outcomes are shared with coronary artery disease.OBJECTIVES: To investigate the efficacy of an acute coronary syndrome regimen in patients hospitalized with COVID-19 and coronary disease risk factors.METHODS: A randomized controlled, open-label trial across acute hospitals (United Kingdom and Brazil) added aspirin, clopidogrel, low-dose rivaroxaban, atorvastatin, and omeprazole to standard care for 28 days. Primary efficacy and safety outcomes were 30-day mortality and bleeding. The key secondary outcome was a daily clinical status (at home, in hospital, on intensive therapy unit admission, or death).RESULTS: Three hundred twenty patients from 9 centers were randomized. The trial terminated early due to low recruitment. At 30 days, there was no significant difference in mortality (intervention vs control, 11.5% vs 15%; unadjusted odds ratio [OR], 0.73; 95% CI, 0.38-1.41; p = .355). Significant bleeds were infrequent and were not significantly different between the arms (intervention vs control, 1.9% vs 1.9%; p > .999). Using a Bayesian Markov longitudinal ordinal model, it was 93% probable that intervention arm participants were more likely to transition to a better clinical state each day (OR, 1.46; 95% credible interval [CrI], 0.88-2.37; Pr [beta > 0], 93%; adjusted OR, 1.50; 95% CrI, 0.91-2.45; Pr [beta > 0], 95%) and median time to discharge to home was 2 days shorter (95% CrI, -4 to 0; 2% probability that it was worse).CONCLUSION: Acute coronary syndrome treatment regimen was associated with a reduction in the length of hospital stay without an excess in major bleeding. A larger trial is needed to evaluate mortality.

Mechanical ventilation patients may breathe spontaneously during ventilator supported breaths, altering airway pressure waveforms and hindering identification of true, underlying respiratory mechanics. This study aims to assess and identify respiratory mechanics for breathing cycles masked by spontaneous breathing (SB) effort using a pressure reconstruction method. The performance of the method is compared to parameters identified using a single-compartment model. Data from two patients (N=6305 breaths) experiencing SB and subsequent periods of muscle paralysis without SB were used for analysis. Patients are their own control and are assessed by breath-to-breath variation using coefficient of variation (CV) of respiratory elastance. Pressure reconstruction successfully estimates more consistent respiratory mechanics during SB by reducing CV up to 78% compared to conventional identification (p 0.05) to conventional identification during paralysis, and generally performs better as paralysis weakens (p

Additional file 1. Resource use.