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Introduction: Cardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians' rationale for performing hs-cTnI tests in an emergency department (ED). Methods: In this prospective study, 1890 patients who underwent hs-cTnI measurement during their stay in an ED were included. Upon arrival, patients were classified into two groups based on their chief complaints: cardiac (36.6%) and non-cardiac (63.4%). Forty-seven ED physicians were asked to complete a questionnaire to assess their perspectives on the use of high-sensitivity cardiac troponin I (hs-cTnI) testing in the ED. Results: Out of the 47 ED physicians who responded to the questionnaire (94% response rate), 97.9% indicated that the purpose of hs-cTnI testing in the ED was to diagnose an acute cardiac event. However, 38.3% reported ordering hs-cTnI tests in non-cardiac patients due to medicolegal concerns. Additionally, 53% admitted to working under medicolegal pressure, and 50% believe they would have ordered fewer hs-cTnI tests if not for this medicolegal threat. Conclusions: defensive medicine is prevalent among ED physicians, and routine use of hs-cTnI testing as part of an evaluation can be explained in part by concern about liability and defensive medicine. [ABSTRACT FROM AUTHOR] more...

Background: Timely reperfusion within 120 min is strongly recommended in patients presenting with non‐ST‐segment myocardial infarction (NSTEMI) with very high‐risk features. Evidence regarding the use of high‐sensitivity cardiac troponin (hs‐cTn) concentration upon admission for the risk‐stratification of patients presenting with NSTEMI to expedite percutaneous coronary intervention (PCI) and thus potentially improve outcomes is limited. Methods: All patients admitted to a tertiary care center ICCU between July 2019 and July 2022 were included. Hs‐cTnI levels on presentaion were recorded, dividing patients into quartiles based on baseline hs‐cTnI. Association between initial hs‐cTnI and all‐cause mortality during up to 3 years of follow‐up was studied. Results: A total of 544 NSTEMI patients with a median age of 67 were included. Hs‐cTnI levels in each quartile were: (a) ≤122, (b) 123–680, (c) 681–2877, and (d) ≥2878 ng/L. There was no difference between the initial hs‐cTnI level groups regarding age and comorbidities. A higher mortality rate was observed in the highest hs‐cTnI quartile as compared with the lowest hs‐cTnI quartile (16.2% vs. 7.35%, p =.03) with hazard ratio (HR) for mortality of 2.6 (95% confidence interval [CI]: 1.23–5.4; p =.012) in the unadjusted model, and HR of 2.06 (95% CI: 1.01–4.79; p =.047) with adjustment for age, gender, serum creatinine, and significant comorbidities. Conclusions: Patients with NSTEMI and higher hs‐cTnI levels upon admission faced elevated mortality risk. This underscores the need for further prospective investigations into early reperfusion strategies' impact on NSTEMI patients' mortality, based on admission troponin elevation. [ABSTRACT FROM AUTHOR] more...

Introduction: D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce. Material and method: All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old). Results and discussion: A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004). Conclusion: Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization. [ABSTRACT FROM AUTHOR] more...

Aims: Lead perforation is a rare, well-known complication of cardiac implantable electronic device (CIED) implants, whose management is mostly not evidence-based. Main management strategies include conservative approach based on clinical and lead function follow-up vs. routine invasive lead revision approach. This study compared the complications of both strategies by composite endpoint, including recurrent perforation-related symptoms, recurrent pericardial effusion (PEf), lead dysfunction, and device infection during 12 month follow-up.Methods and Results: Multicentre retrospective analysis, inquiring data from imaging studies, device interrogation, pericardiocentesis, and clinical charts of patients with suspected perforating leads between 2007 and 2014 in five hospitals. All cases were reviewed by electrophysiologist and defined as definite perforations by suggestive symptoms along with lead perforation on imaging, bloody PEf on pericardiocentesis shortly after implant, or right ventricular (RV) lead non-capture along with diaphragmatic stimulation upon bipolar pacing. Clinical outcomes associated with both management approaches were compared, with respect to the composite endpoint. The study included 48 definitive perforation cases: 22 managed conservatively and 26 via lead revision. Conservative management was associated with an increased composite endpoint compared with lead revision (8/22 vs. 1/26; P = 0.007). The dominant complication among the conservative cohort was appearance of cardiac tamponade during follow-up; 5/6 occurring in cases which presented with no or only mild PEf and were treated by antiplatelets/coagulants during or shortly after CIED implantation.Conclusion: A conservative management of CIED lead perforation is associated with increased complications compared with early lead revision. Lead revision may be the preferred management particularly in patients receiving antiplatelets/coagulants. [ABSTRACT FROM AUTHOR] more...

Aims: Lead perforation is a rare, well-known complication of cardiac implantable electronic device (CIED) implants, whose management is mostly not evidence-based. Main management strategies include conservative approach based on clinical and lead function follow-up vs. routine invasive lead revision approach. This study compared the complications of both strategies by composite endpoint, including recurrent perforation-related symptoms, recurrent pericardial effusion (PEf), lead dysfunction, and device infection during 12 month follow-up., Methods and Results: Multicentre retrospective analysis, inquiring data from imaging studies, device interrogation, pericardiocentesis, and clinical charts of patients with suspected perforating leads between 2007 and 2014 in five hospitals. All cases were reviewed by electrophysiologist and defined as definite perforations by suggestive symptoms along with lead perforation on imaging, bloody PEf on pericardiocentesis shortly after implant, or right ventricular (RV) lead non-capture along with diaphragmatic stimulation upon bipolar pacing. Clinical outcomes associated with both management approaches were compared, with respect to the composite endpoint. The study included 48 definitive perforation cases: 22 managed conservatively and 26 via lead revision. Conservative management was associated with an increased composite endpoint compared with lead revision (8/22 vs. 1/26; P = 0.007). The dominant complication among the conservative cohort was appearance of cardiac tamponade during follow-up; 5/6 occurring in cases which presented with no or only mild PEf and were treated by antiplatelets/coagulants during or shortly after CIED implantation., Conclusion: A conservative management of CIED lead perforation is associated with increased complications compared with early lead revision. Lead revision may be the preferred management particularly in patients receiving antiplatelets/coagulants., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.) more...