Occlusion-focused ECG triage found twice as many acute coronary occlusions within two hours

The edition in brief

In 4,398 patients without diagnostic ST elevation in the cluster-randomised DIFOCCULT-3 trial, an occlusion-focused (OMI/NOMI) approach selected 45.4% for immediate invasive management against 13.6% under the conventional STEMI/NSTEMI framework, and identified adjudicated acute coronary occlusion within two hours in 35.1% against 16.7%, without lowering angiographic yield. Guideline very-high-risk NSTEMI criteria captured few patients and were inconsistently acted on. A post hoc analysis of 173 VANISH patients with septic shock found that high proenkephalin, a renal function marker, was linked to 28-day mortality (OR 3.24), and that among those reaching maximal vasopressor doses, high-proenkephalin patients given hydrocortisone had the fewest kidney-failure-free days; the analysis is exploratory. Across 2.14 million US Medicare ICU stays, hospitals with tele-critical care transferred slightly more patients but had fewer transfers ending in death or hospice within a day.