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Diagnostic accuracy and clinical utility of the novel Siemens-hs-cTnI-Centaur assay are high and comparable with the established hs-cTn assays. ClinicalTrials.gov Identifier: NCT00470587.

ObjectiveAssess the relative incidence and compare characteristics and outcome of unstable angina (UA) and non-ST-elevation myocardial infarction (NSTEMI).DesignTwo independent prospective multicentre diagnostic studies (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] and High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome [High-STEACS]) enrolling patients with acute chest discomfort presenting to the emergency department. Central adjudication of the final diagnosis was done by two independent cardiologists using all clinical information including serial measurements of high-sensitivity cardiac troponin (hs-cTn). All-cause death and future non-fatal MI were assessed at 30 days and 1 year.Results8992 patients were enrolled at 11 centres. UA was adjudicated in 8.9%(95% CI 8.0 to 9.7) and 2.8% (95% CI 2.3 to 3.3) patients in APACE and High-STEACS, respectively, and NSTEMI in 15.1% (95% CI 14.0 to 16.2) and 13.4% (95% CI 12.4 to 14.3). Coronary artery disease was pre-existing in 73% and 76% of patients with UA. At 30 days, all-cause mortality in UA was substantially lower as compared with NSTEMI (0.5% vs 3.7%, p=0.002 in APACE, 0.7% vs 7.4%, p=0.004 in High-STEACS). Similarly, at 1 year in UA all-cause mortality was 3.3% (95% CI 1.2 to 5.3) vs 10.4% (95% CI 7.9 to 12.9) in APACE, and 5.1% (95% CI 0.7 to 9.5) vs 22.9% (95% CI 19.3 to 26.4) in High-STEACS, and similar to non-cardiac chest pain (NCCP). In contrast, future non-fatal MI in APACE was comparable in UA and NSTEMI (11.2%, 95% CI 7.8 to 14.6 and 7.9%, 95% CI 5.7 to 10.2), and higher than in NCCP (0.6%, 95% CI 0.2 to 1.0).ConclusionsThe relative incidence and mortality of UA is substantially lower than that of NSTEMI, while the rate of future non-fatal MI is similar.

Low-volume resuscitation with HBOC-201 provides adequate tissue oxygenation for survival in a porcine model of controlled hemorrhagic shock with no long-term organ dysfunction identified. Although some animals did show mild hepatocellular damage with elevations of aspartate aminotransferase at day 2, these findings did not appear to have clinical relevance, and the enzyme elevations were trending toward normal by the third postoperative day. Decreases in hemoglobin levels at the later time points were expected, given the half-life of the product.

Thyroid doses in 71% of study patients fell within the dose range historically correlated with an increased risk of thyroid cancer and whole body effective doses fell within the range of historical doses correlated with an increased risk of all solid cancers and leukemia. Selective scanning of body areas as compared with whole body scanning results in a statistically significant decrease in all doses.

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P atients with symptoms suggestive of acute myocardial infarction (AMI) account for ≈10% of all emergency department (ED) presentations. 1 The majority of patients are finally found to have diagnoses other than AMI. 2 Thus, the expeditious evaluation of such patients is important because delays in ruling out AMI may interfere with the detection of other underlying diseases. The 0/1 hour (0/1h) algorithm and the 0/3 hour (0/3h) algorithm are both recommended by the European Society of Cardiology with a Class I recommendation for the early rule-out of AMI. 1 The 0/1h algorithm and 0/3h algorithm are completely different protocols. Whereas the 0/1h algorithm uses high-sensitivity cardiac troponin (hs-cTn) concentrations at presentation and absolute changes within the first hour and hence takes optimal advantage of the increased diagnostic accuracy and precision of hs-cTn assays, the 0/3h algorithm uses a fixed threshold protocol based on the 99th percentile at presentation and 3 hours in conjunction with clinical criteria (GRACE [Global Registry of Acute Coronary Events] score <140 and the need to be pain free). It is currently unknown whether 1 algorithm is preferable to the other. The aim of this study was to directly compare safety, quantified by the negative predictive value (NPV) and the negative likelihood ratio (LR) for the presence of AMI, and efficacy, quantified by the proportion of patients triaged toward rule-out in a large diagnostic multicenter study enrolling patients presenting with suspected AMI to the ED (URL: https://www.clinicaltrials.gov. Unique identifier: NCT00470587). The study was carried out according to the principles of the Declaration of Helsinki and approved by the local ethics committees. Written informed consent was obtained from all patients. Patients presenting with ST-segment-elevation MI were excluded. Triage toward rule-out by the 0/1h or the 0/3h algorithm was compared against the final adjudication performed by 2 independent cardiologists using all information, including cardiac imaging and serial hs-cTnT measurements. Analyses were performed with hs-cTnT and hs-cTnI. NPV and efficacy were compared by the McNemar test and Pearson χ 2 test, respectively. The 95% confidence intervals (CIs) were calculated with the Wilson score method without continuity correction. Among 2547 patients eligible for analysis with hs-cTnT, AMI was the final adjudicated diagnosis in 387 patients (15%). The 0/1h algorithm provided safety similar to that of the 0/3h algorithm (NPV, 99.8% [95% CI, 99.4-99.9] and negative LR, 0.01 [95% CI, 0.00-0.03] versus NPV, 99.7% [95% CI, 99.2-99.9] and negative LR, 0.02 [95% CI, 0.00-0.05]) but allowed the rule-out of significantly more patients compared with the 0/3h algorithm (60% versus 44%; P<0.001). Among 2197 patients eligible for analysis with hs-cTnI, AMI was the final diagnosis in 327 patients (15%). The 0/1h algorithm provided higher safety compared with the 0/3h algorithm (NPV, 99.6% [95% CI, 99.1-99.9%] and negative LR, 0.02 [95% CI, 0.01-0.05] versus NP...