Did the introduction of high-sensitivity Troponin T for the assessment of suspected acute coronary syndrome in Malta result in reduction of hospitalization time? A retrospective review

Aims: Troponins I and T are biomarkers used for diagnosing myocardial infarction. The recently developed high-sensitivity Troponin T assay can detect levels as low as 3 ng/L which gives the advantage of rapid diagnosis of acute coronary syndrome (ACS) allowing earlier intervention and theoretically earlier discharge. The aim of the study was to audit the hospital practice and its adherence to international guidelines in using Troponin for diagnosing ACS, and to assess the average hospital admission length when using Troponin T compared to the older Troponin I. Methodology: A retrospective study that included all patients who had Troponin T taken between January 1st and January 31st, 2016 at Mater Dei Hospital (MDH), comparing them to patients who had Troponin I taken between November 1st and November 30th, 2015. Results: Data collection yielded a total of 1,032 patients in the Troponin T group and 1,004 patients in the Troponin I group. The average length of stay when using Troponin T was 5.53 days whereas the average length of stay when using Troponin I was 8.29 days. Data analysis of those patients also showed that the average time interval between the first and second Troponin was in the region of 9 hours, which is not what the current guidelines recommend. Conclusion: The use of the new highly sensitive Troponin T resulted in an average reduction in hospitalization time of 2.76 days per patient at MDH. Adherence to the “0/3 hours” guideline of the second Troponin is highly recommended.peer-reviewe

A Modified Bat Algorithm with Conjugate Gradient Method for Global Optimization

Metaheuristic algorithms are used to solve many optimization problems. Firefly algorithm, particle swarm improvement, harmonic search, and bat algorithm are used as search algorithms to find the optimal solution to the problem field. In this paper, we have investigated and analyzed a new scaled conjugate gradient algorithm and its implementation, based on the exact Wolfe line search conditions and the restart Powell criterion. The new spectral conjugate gradient algorithm is a modification of the Birgin and Martínez method, a manner to overcome the lack of positive definiteness of the matrix defining the search direction. The preliminary computational results for a set of 30 unconstrained optimization test problems show that this new spectral conjugate gradient outperforms a standard conjugate gradient in this field and we have applied the newly proposed spectral conjugate gradient algorithm in bat algorithm to reach the lowest possible goal of bat algorithm. The newly proposed approach, namely, the directional bat algorithm (CG-BAT), has been then tested using several standard and nonstandard benchmarks from the CEC’2005 benchmark suite with five other algorithms and has been then tested using nonparametric statistical tests and the statistical test results show the superiority of the directional bat algorithm, and also we have adopted the performance profiles given by Dolan and More which show the superiority of the new algorithm (CG-BAT)

Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement

Background Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. Methods and Results A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C‐statistic 0.78 for TRITAVIpre and C‐statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C‐statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1‐year mortality (from 6.9% to 54.4%; P=0.0001). Conclusions A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement

Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement

Background: Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. Methods and results: A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance &lt;30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C-statistic 0.78 for TRITAVIpre and C-statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C-statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1-year mortality (from 6.9% to 54.4%; P=0.0001). Conclusions: A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement