In This Issue February 2018 Volume 3, Number 2 JAMA Cardiology Pages 93-184 Research Opinion Editorial High-Sensitivity Troponin T in Acute Coronary Syndrome 104 99 Menopausal Hormone Therapy for the Information is needed on how to use the first available high-sensitivity troponin (hsTnT) as- Primary Prevention of Chronic Conditions: say in the United States to identify patients at very low risk for adverse cardiac events. In Unfulfilled Expectations an observational study of 1355 patients with suspected acute coronary syndrome at 15 emer- NK Wenger 102 Understanding How to Improve gency departments between 2011 and 2015, Peacock and coauthors determined whether Quality and Value for Patients With Acute a negative high-sensitivity troponin assay could identify patients at less than 1% risk of a Myocardial Infarction 30-day adverse cardiac event. In 974 of 1264 patients (77.1%) with both 0-hour and 3-hour JH Wasfy and RW Yeh high-sensitivity troponin levels of 19 ng/L or less, the negative predictive value for 30-day Invited Commentary adverse cardiac events was 99.3%. In an Invited Commentary, Korley cautions that more 112 The Wait for High-Sensitivity Troponin data are needed on the safety of accelerated rule-out strategies. Is Over—Proceed Cautiously Invited Commentary 112 FK Korley 130 Complete Revascularization for Medicare Expenditure Growth and Cardiovascular Outcomes 114 Percutaneous Coronary Intervention: The association between Medicare spending growth over the last 2 decades and cardio- The Devil Is in the Details WS Weintraub vascular outcomes has not been fully assessed. In a cross-sectional analysis of 479 893 fee- for-service Medicare beneficiaries admitted with acute myocardial infarction to 1220 hos- 142 Coronary Revascularization for Veterans—There’s No Place Like Home pitals, Likosky and coauthors report that adjusted expenditures per patient increased 13.9% FS Resnic and G Gadey from 1999-2000 to 2013-2014. Increases in early percutaneous coronary intervention and 153 High-Risk Coronary Atherosclerotic postacute care were associated with reduced 180-day case fatality, whereas spending on Plaque Assessment by Coronary cardiac procedures was associated with increased 180-day mortality. Wasfy and Yeh con- Computed Tomography tend in an Editorial that requisite payment reform has created the urgency for generating Angiography—Should We Use It? this type of knowledge and implementing strategies to improve quality of care for acute RJ Gibbons myocardial infarction. Clinical Review & Education Editorial 102 Author Audio Interview jamacardiology.com Review Coronary Revascularization in Veterans Affairs Hospitals 133 Time The Veterans Affairs (VA) Community Care (CC) Program supplements VA hospital care with community-based medical services, but its value for elective coronary revascularization is 1 Episode Year(s) uncertain. Barnett and coauthors assessed access, cost, and quality for 13 237 elective per- cutaneous coronary interventions (79.1% at the VA) and 5818 elective coronary artery by- pass graft procedures (83.6% at the VA) from 2008 through 2011. Despite higher cost, ad- Months Days justed 30-day mortality after percutaneous coronary intervention was higher in CC hospitals Weeks compared with VA hospitals. Coronary artery bypass graft costs were lower at CC hospitals than at VA hospitals, with no difference in adjusted 30-day mortality. In an Invited Com- 169 Association of Exercise mentary, Resnic and Gadey emphasize the powerful effect of the VA integrated health care Preconditioning With Immediate system on costs and patient outcomes. Cardioprotection: A Review Invited Commentary 142 DHJ Thijssen and Coauthors Author Audio Interview jamacardiology.com 181 Correction Elevated Urinary Albumin to Creatinine Ratios 155 Whether an elevated level of urinary albumin to creatinine ratio (UACR), a predictor of kid- ney failure and death in patients with type 2 diabetes, provides incremental prognostic value beyond established risk factors and biomarkers is uncertain. Scirica and coauthors evalu- ated UACR values in 15 760 patients enrolled in the SAVOR-TIMI 53 study from 2010 to 2013. Higher values of UACR were associated with the primary composite end point of cardio- Departments vascular death, myocardial infarction, or ischemic stroke over a median follow-up of 2.1 years. 96 Staff Listing However, the incremental cardiovascular prognostic value of UACR was minimal when evalu- 169 CME Article ated together with contemporary cardiac biomarkers. 183 Contact Information 184 CME Questions jamacardiology.com (Reprinted) JAMA Cardiology February 2018 Volume 3, Number 2 95 © 2018 American Medical Association. All rights reserved.
JAMA Cardiology – American Medical Association
Published: Feb 1, 2018
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