ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

/pdf/2015-esc-guidelines-for-the-management-of-acute-coronary-6did6h5nxk.pdf

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

tion’, implying that most patients ‘should’ receive a particular action. In contrast, level 2 guidelines are essentially ‘suggestions’ and are deemed to be ‘weak’ or discretionary, recognising that management decisions may vary in different clinical contexts. Each recommendation was further graded from A to D by the quality of evidence underpinning them, with grade A referring to a high quality of evidence whilst grade D recognised a ‘very low’ evidence base. The overall strength and quality of the supporting evidence is summarised in table 1 . The guidelines focused on 4 key domains: (1) AKI definition, (2) prevention and treatment of AKI, (3) contrastinduced AKI (CI-AKI) and (4) dialysis interventions for the treatment of AKI. The full summary of clinical practice statements is available at www.kdigo.org, but a few key recommendation statements will be highlighted here.

/pdf/kdigo-clinical-practice-guidelines-for-acute-kidney-injury-27tybolw7l.pdf

KDIGO clinical practice guidelines for acute kidney injury.

2018 ESC/EACTS Guidelines on myocardial revascularization.

Authors/Task Force Members: Franz-Josef Neumann* (ESC Chairperson) (Germany), Miguel Sousa-Uva* (EACTS Chairperson) (Portugal), Anders Ahlsson (Sweden), Fernando Alfonso (Spain), Adrian P. Banning (UK), Umberto Benedetto (UK), Robert A. Byrne (Germany), Jean-Philippe Collet (France), Volkmar Falk (Germany), Stuart J. Head (The Netherlands), Peter Jüni (Canada), Adnan Kastrati (Germany), Akos Koller (Hungary), Steen D. Kristensen (Denmark), Josef Niebauer (Austria), Dimitrios J. Richter (Greece), Petar M. Seferovi c (Serbia), Dirk Sibbing (Germany), Giulio G. Stefanini (Italy), Stephan Windecker (Switzerland), Rashmi Yadav (UK), Michael O. Zembala (Poland) Document Reviewers: William Wijns (ESC Review Co-ordinator) (Ireland), David Glineur (EACTS Review Co-ordinator) (Canada), Victor Aboyans (France), Stephan Achenbach (Germany), Stefan Agewall (Norway), Felicita Andreotti (Italy), Emanuele Barbato (Italy), Andreas Baumbach (UK), James Brophy (Canada), Héctor Bueno (Spain), Patrick A. Calvert (UK), Davide Capodanno (Italy), Piroze M. Davierwala

/pdf/2014-esc-eacts-guidelines-on-myocardial-revascularization-3fr5n9jz36.pdf

2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).

Guidelines and Expert Consensus Documents summarize and evaluate all available evidence with the aim of assisting physicians in selecting the best management strategy for an individual patient suffering from a given condition, taking into account the impact on outcome and the risk–benefit ratio of diagnostic or therapeutic means. Guidelines are no substitutes for textbooks and their legal implications have been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily practice. However, the ultimate judgement regarding the care of an individual patient must be made by his/her responsible physician(s).

The recommendations for formulating and issuing ESC Guidelines and Expert Consensus Documents can be found on the ESC website (http://www.escardio.org/knowledge/guidelines/rules).

Members of this Task Force were selected by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) to represent all physicians involved with the medical and surgical care of patients with coronary artery disease (CAD). A critical evaluation of diagnostic and therapeutic procedures is performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for society are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to predefined scales, as outlined in Tables 1 and 2 .

View this table:

Table 1 
Classes of recommendations



View this table:

Table 2 
Levels of evidence



The members of the Task Force have provided disclosure statements of all relationships that might be perceived as real or potential sources of conflicts of interest. These disclosure forms are kept on file at European Heart House, headquarters of the ESC. Any changes in conflict of interest that arose during the writing period were notified to the ESC. The Task Force report received its entire financial support from the ESC and EACTS, without any involvement of the pharmaceutical, device, or surgical industry.

ESC …

/pdf/guidelines-on-myocardial-revascularization-the-task-force-on-3qs3gmu7h5.pdf

Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)

ContextContrast-induced nephropathy remains a common complication of radiographic
procedures. Pretreatment with sodium bicarbonate is more protective than sodium
chloride in animal models of acute ischemic renal failure. Acute renal failure
from both ischemia and contrast are postulated to occur from free-radical
injury. However, no studies in humans or animals have evaluated the efficacy
of sodium bicarbonate for prophylaxis against contrast-induced nephropathy.ObjectiveTo examine the efficacy of sodium bicarbonate compared with sodium chloride
for preventive hydration before and after radiographic contrast.Design, Setting, and PatientsA prospective, single-center, randomized trial conducted from September
16, 2002, to June 17, 2003, of 119 patients with stable serum creatinine levels
of at least 1.1 mg/dL (≥97.2 µmol/L) who were randomized to receive
a 154-mEq/L infusion of either sodium chloride (n = 59) or sodium bicarbonate
(n = 60) before and after iopamidol administration (370 mg iodine/mL). Serum
creatinine levels were measured at baseline and 1 and 2 days after contrast.InterventionsPatients received 154 mEq/L of either sodium chloride or sodium bicarbonate,
as a bolus of 3 mL/kg per hour for 1 hour before iopamidol contrast, followed
by an infusion of 1 mL/kg per hour for 6 hours after the procedure.Main Outcome MeasureContrast-induced nephropathy, defined as an increase of 25% or more
in serum creatinine within 2 days of contrast.ResultsThere were no significant group differences in age, sex, incidence of
diabetes mellitus, ethnicity, or contrast volume. Baseline serum creatinine
was slightly higher but not statistically different in patients receiving
sodium bicarbonate treatment (mean [SD], 1.71 [0.42] mg/dL [151.2 {37.1} µmol/L]
for sodium chloride and 1.89 [0.69] mg/dL [167.1 {61.0} µmol/L] for
sodium bicarbonate; P = .09). The primary end point
of contrast-induced nephropathy occurred in 8 patients (13.6%) infused with
sodium chloride but in only 1 (1.7%) of those receiving sodium bicarbonate(mean
difference, 11.9%; 95% confidence interval [CI], 2.6%-21.2%; P = .02). A follow-up registry of 191 consecutive patients receiving
prophylactic sodium bicarbonate and meeting the same inclusion criteria as
the study resulted in 3 cases of contrast-induced nephropathy (1.6%; 95% CI,
0%-3.4%).ConclusionHydration with sodium bicarbonate before contrast exposure is more effective
than hydration with sodium chloride for prophylaxis of contrast-induced renal
failure.

https://jamanetwork.com/journals/jama/articlepdf/198760/JOC32654.pdf

H. James Norton

Papers

Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate: A Randomized Controlled Trial

Prevention of Contrast-Induced Nephropathy With Sodium Bicarbonate