Implementation and evaluation of a CYP2C19 genotype-guided antiplatelet therapy algorithm in high-risk coronary artery disease patients.

AIM: An algorithm that uses clinical factors and CYP2C19 genotype to guide P2Y12 inhibitor selection in high-risk patients undergoing percutaneous coronary intervention was implemented at our institution. We sought to evaluate use of this algorithm and identify which factors influenced P2Y12 inhibitor selection. PATIENTS & METHODS: This retrospective cohort study included 264 patients receiving percutaneous coronary intervention from July-December 2012. RESULTS: CYP2C19 genotype was obtained in 229 patients; of these, 30% were intermediate or poor metabolizers. CYP2C19 intermediate or poor metabolizer phenotype was among the strongest predictors for selecting prasugrel or ticagrelor as maintenance therapy (p < 0.001), and was the only significant predictor of a change in therapy (p < 0.001). CONCLUSION: These findings suggest that using CYP2C19 genotype to guide P2Y12 inhibitor selection is feasible. Original submitted 27 October 2014; revision submitted 19 December 2014.

Relation of atrial fibrillation burden and N-terminal pro-brain natriuretic peptide.

Previous studies have noted a correlation between the presence of atrial fibrillation (AF) and elevated brain natriuretic peptide hormone level, although the exact nature of this association is unclear. Understanding the relation between AF and brain natriuretic peptide may enhance care for this patient population. The aim of this study was to establish the relationship between AF burden and N-terminal pro-brain natriuretic peptide (NT-proBNP) level. One hundred eighty-four patients who presented to the University of North Carolina electrophysiology clinic with AF underwent baseline questionnaires, laboratory testing (including NT-proBNP), echocardiography, and 1-week ambulatory rhythm monitoring. Multivariate linear regression was used to determine the association between AF burden and NT-proBNP level. Increased AF burden was associated with increased NT-proBNP level, and this association remained significant after adjusting for possible confounders. Compared with a 0% AF burden, those with an AF burden of 1% to 25% had a nearly 1.5-fold increase (p = 0.102), those with an AF burden of 26% to 99% had a nearly fourfold increase (p <0.001), and those with an AF burden of 100% had a nearly 4.5-fold increase (p <0.001). In conclusion, AF burden as assessed by continuous 1-week ambulatory rhythm monitoring is directly associated with NT-proBNP level. NT-proBNP may act as a useful surrogate for assessing AF burden.

Testicular ascent as a mechanism for intra-abdominal torsion.

Testicular ascent, while uncommon, can occur. A testicle that has ascended out of the scrotum can torse and may present as an acute inguinal mass or acute abdomen. Testicle ascent can occur even if previous intra-scrotal location has been documented.