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Cardiology 

347A Randomized Controlled Trial of Magnesium Sulfate, in Addition to Usual Care, for Rate Control in Atrial Fibrillation (Original Research)

MJ Davey, D Teubner

What is already known on this topic: Many patients presenting to the emergency department with rapid atrial fibrillation require rate reduction. What question this study addressed: This randomized controlled trial examined whether the addition of magnesium sulfate to standard therapies for patients with atrial fibrillation would enhance reduction in the pulse rate. What this study adds to our knowledge: When added to other standard therapies, intravenous magnesium facilitated a reduction in pulse rate, and patients were more likely to reach a pulse rate below 100 beats/min within 2.5 hours after treatment was initiated. How this might change clinical practice: Patients with atrial fibrillation who require rapid pulse rate reduction may benefit from the addition of intravenous magnesium to other rate reduction therapies.

355Influence of Timing of Troponin Elevation on Clinical Outcomes and Use of Evidence-Based Therapies for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes (Original Research)

MT Roe, ED Peterson, CV Pollack, Jr, LK Newby, Y Li, RH Christenson, WF Peacock, FM Fesmire, D Diercks, JD Kirk, SC Smith, Jr, EM Ohman, WB Gibler, for the CRUSADE Investigators

What is already known on this topic: In patients with acute coronary syndromes, cardiac marker elevations predict a poorer outcome. What question this study addressed: This study addressed whether initial cardiac marker elevations (compared with later marker elevations or no marker elevations) improve adherence with American College of Cardiology/American Heart Association guidelines for patients with non-ST-segment elevation acute coronary syndromes. What this study adds to our knowledge: In 23,184 patients, guideline-recommended therapies are underused, even in high-risk patients identified within the first few hours of presentation. How this might change clinical practice: This study found suboptimal compliance with guidelines for a high-risk group of patients with acute coronary syndromes. Emergency physicians should pay more attention to the evidence-based guidelines, particularly for patients with high-risk features such as positive initial cardiac markers.

3632004 American College of Cardiology/American Heart Association Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: Implications for Emergency Department Practice (Special Contribution)

CV Pollack, Jr, DB Diercks, MT Roe, ED Peterson

The American College of Cardiology and the American Heart Association last published evidence-based guidelines for the management of ST-segment elevation myocardial infarction (STEMI) in 1999. In mid-2004, in recognition of the improvement and evolution of many of the most basic tenets of clinical management of STEMI since that time, an updated edition of the STEMI guidelines has been published. These guidelines offer many evidence-based recommendations that are pertinent to the out-of-hospital and emergency department care of STEMI patients, including initial evaluation, risk stratification, stabilizing management, and the choice between pharmacologic and mechanical revascularization. These are presented and discussed here.

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