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Coronary Risk Stratification of Chest Pain

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1. Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain. (PubMed)

Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain. The number of patients presenting to the emergency department (ED) with suspected acute coronary syndrome (ACS) is substantial. We tested whether identification of coronary artery calcium (CAC) can improve the negative predictive value (NPV) of clinical risk assessment for ACS in patients with acute chest pain.We included 826 consecutive patients (mean age: 53±11years; 42% female (...) was 16% for ≥50% stenosis and 8.7% for ≥70% stenosis. The incidence of ACS was 7.9%, (MI=11, UAP=54). The NPV of CAC=0 was 99.5% for ACS. The NPV of a combination of TIMI score=0 and no CAC was 89% for any CAD (any plaque or stenosis) and 99.7% for ≥50% stenosis. A 100% NPV was found for ≥70% stenosis and ACS, correctly identifying 328 (40%) patients.The exclusion of CAC, in combination with clinical risk assessment, has high clinical value in patients with acute chest pain, as it identifies patients

2017 International journal of cardiology

2. Chronic Chest Pain-Noncardiac Etiology Unlikely: Low to Intermediate Probability of Coronary Artery Disease

in terms of outcomes [25,43]. In addition, the use of stress MPI improved clinical decision making for chest pain patients [44]. CT Coronary Calcium CCS can be used as a diagnostic tool when evaluating patients with chest pain [45]. In patients presenting with stable angina, a positive CCS score is more accurate than clinical risk stratification tools, such as the Diamond Forrester risk stratification tool, for determining which patients have CAD [46]. CCS is also predictive of which patients may have (...) in patients with acute chest pain. Acad Emerg Med 2012;19:934-42. 2. Fernandez-Friera L, Garcia-Alvarez A, Guzman G, Garcia MJ. Coronary CT and the coronary calcium score, the future of ED risk stratification? Curr Cardiol Rev 2012;8:86-97. 3. Bom MJ, Van der Zee PM, Van der Zant FM, Knol RJ, Cornel JH. Independent prognostic value of coronary artery calcium score and coronary computed tomography angiography in an outpatient cohort of low to intermediate risk chest pain patients. Neth Heart J 2016;24:332

2018 American College of Radiology

3. Coronary Risk Stratification of Chest Pain

Coronary Risk Stratification of Chest Pain Coronary Risk Stratification of Chest Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 (...) Coronary Risk Stratification of Chest Pain Coronary Risk Stratification of Chest Pain Aka: Coronary Risk Stratification of Chest Pain , Likelihood of Coronary Disease as Cause of Chest Pain , Chest Pain Prediction Rules , Chest Pain Decision Rules From Related Chapters II. Risk Factors See s See III. Diagnosis: Prediction Rules IV. Criteria: High Likelihood Known history Typical l symptoms Men over age 60 Women over age 70 Characteristic symptoms radiating to the right arm or (LR+ 4.7) radiating

2018 FP Notebook

4. 3 for the Price of 1: Teaching Chest Pain Risk Stratification in a Multidisciplinary, Problem-based Learning Workshop (PubMed)

3 for the Price of 1: Teaching Chest Pain Risk Stratification in a Multidisciplinary, Problem-based Learning Workshop Chest pain is a common chief complaint among patients presenting to health systems and often leads to complex and intensive evaluations. While these patients are often cared for by a multidisciplinary team (primary care, emergency medicine, and cardiology), medical students usually learn about the care of these patients in a fragmented, single-specialty paradigm. The present (...) and future care of patients with chest pain is multidisciplinary, and the education of medical students on the subject should be as well. Our objective was to evaluate the effectiveness of a multidisciplinary, problem-based learning workshop to teach third-year medical students about risk assessment for patients presenting with chest pain, specifically focusing on acute coronary syndromes.To create an educational experience consistent with multidisciplinary team-based care, we designed

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2018 Western Journal of Emergency Medicine

5. Acute coronary syndrome risk prediction of rapid emergency medicine scoring system in acute chest pain: An observational study of patients presenting with chest pain in the emergency department in Central Saudi Arabia (PubMed)

Acute coronary syndrome risk prediction of rapid emergency medicine scoring system in acute chest pain: An observational study of patients presenting with chest pain in the emergency department in Central Saudi Arabia To assess the diagnostic validity of the rapid emergency medical score (REMS) for the risk stratification of acute coronary syndrome (ACS) from non-cardiogenic chest pain. Methods: An observational cross-sectional study was carried out among patients presenting with chest pain

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2017 Saudi medical journal

6. Chronic Chest Pain - High Probability of Coronary Artery Disease

assessment is necessary to determine the pretest probability of CAD. Multiple methods are available to categorize patients as low, medium, or high risk of developing CAD. Existing methods, including the Diamond and Forrester method, Framingham risk score, coronary calcium score (CCS), and Duke Clinical Score, are based on different criteria such as age, gender, family history of CAD, type of chest pain, lipid levels, and previous cardiovascular events. One study suggests that the Diamond and Forrester (...) , radiographs (including fluoroscopy) are insensitive for detecting coronary arterial calcification [6]. Chest radiography, therefore, is of limited value in symptomatic patients with a high risk of CAD. Imaging of Myocardium Single-photon emission computed tomography Stress SPECT MPI demonstrates relative myocardial perfusion defects, indicating the presence of myocardial ischemia. For this reason, it is considered an important first-line study in the evaluation of patients with chronic chest pain

2016 American College of Radiology

7. Best Clinical Practice: Current Controversies in the Evaluation of Low-Risk Chest Pain with Risk Stratification Aids. Part 2. (PubMed)

Best Clinical Practice: Current Controversies in the Evaluation of Low-Risk Chest Pain with Risk Stratification Aids. Part 2. Chest pain accounts for 10% of emergency department (ED) visits annually, and many of these patients are admitted because of potentially life-threatening conditions. A substantial percentage of patients with chest pain are at low risk for a major cardiac adverse event (MACE).We investigated controversies in the evaluation of patients with low-risk chest pain, including (...) clinical scores, decision pathways, and shared decision-making.ED patients with chest pain who have negative biomarker results and nonischemic electrocardiograms are at low risk for MACE. With the large number of chest pain patients evaluated in the ED, several risk scores and pathways are in use based on history, electrocardiographic results, and biomarker results. The Thrombolysis in Myocardial Infarction and Global Registry of Acute Coronary Events scores are older rules with validation; however

2016 Journal of Emergency Medicine

8. Add-on tests for improving risk-stratification in emergency department patients with chest pain who are at low to moderate risk of 30-day major adverse cardiac events. (PubMed)

Add-on tests for improving risk-stratification in emergency department patients with chest pain who are at low to moderate risk of 30-day major adverse cardiac events. Chest pain patients commonly present to emergency departments (ED), and require either hospital admission and/or lengthy diagnostic protocols to rule-out myocardial infarction. We aimed to identify the best combination of add-on tests to high-sensitivity cardiac troponin (hs-cTnT) for predicting 30-day major adverse cardiac (...) from raw coefficients of model 5. The risk score provided excellent calibration (P=0.91) and discrimination (AUC 0.87, 95% CI: 0.82 to 0.93).Appropriate early risk-stratification of patients with chest pain and possible ACS using a combination of ECG and one-time hs-cTnT may improve efficiency of care.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

2016 International journal of cardiology

9. High-Sensitivity Cardiac Troponin T to OPtimize Chest Pain Risk Stratification

High-Sensitivity Cardiac Troponin T to OPtimize Chest Pain Risk Stratification High-Sensitivity Cardiac Troponin T to OPtimize Chest Pain Risk Stratification - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more (...) . High-Sensitivity Cardiac Troponin T to OPtimize Chest Pain Risk Stratification (STOP CP) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02984436 Recruitment Status : Active, not recruiting First Posted : December 7, 2016 Last Update Posted : January 14, 2019 Sponsor: University of Florida

2016 Clinical Trials

10. Chest Pain Risk Stratification: A Comparison of the 2-Hour Accelerated Diagnostic Protocol (ADAPT) and the HEART Pathway. (PubMed)

Chest Pain Risk Stratification: A Comparison of the 2-Hour Accelerated Diagnostic Protocol (ADAPT) and the HEART Pathway. The 2-hour accelerated diagnostic protocol (ADAPT) and the history electrocardiogram age risk factors troponin (HEART) Pathway are decision aids designed to identify Emergency Department (ED) patients with chest pain who are safe for early discharge. Both have demonstrated high sensitivity (>99%) for major adverse cardiac events (MACE) at 30 days and early discharge rates (...) : 17-32%) as low-risk, whereas the Heart pathway identified 66 of 141 patients (47%, 95% CI: 38-55%) as low risk (P < 0.001).Within a cohort of ED patients with acute chest pain, ADAPT and the HEART pathway had high sensitivity for MACE. The HEART pathway outperformed ADAPT by correctly identifying more patients as low risk and safe for early discharge.

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2016 Critical Pathways in Cardiology

11. Triple rule-out computed tomography for risk stratification of patients with acute chest pain. (PubMed)

Triple rule-out computed tomography for risk stratification of patients with acute chest pain. Clinical evidence supporting triple rule-out computed tomography (TRO-CT) for rapid screening of cardiovascular disease is limited. We investigated the clinical value of TRO-CT in patients with acute chest pain.We retrospectively enrolled 1024 patients who visited the emergency department (ED) with acute chest pain and underwent TRO-CT using a 128-slice CT system. TRO-CT was classified as "positive (...) " if it revealed clinically significant cardiovascular disease including obstructive coronary artery disease, pulmonary thromboembolism, or acute aortic syndrome. The clinical endpoint was occurrence of a major adverse cardiovascular event (MACE) within 30 days, defined by a composite of all cause death, myocardial infarction, revascularization, major cardiovascular surgery, or thrombolytic therapy. Clinical risk scores for acute chest pain including TIMI, GRACE, Diamond-Forrester, and HEART were determined

2016 Journal of cardiovascular computed tomography

12. Implementation of a Risk Stratification and Management Pathway for Acute Chest Pain in the Emergency Department (PubMed)

Implementation of a Risk Stratification and Management Pathway for Acute Chest Pain in the Emergency Department Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources.From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing (...) a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score. In addition to capturing adherence to the SCAMP algorithm and reasons for any deviations, we measured troponin sample timing; rates of stress test utilization; length of stay (LOS); and 30-day rates of revascularization, ACS, and death.We identified 239 patients during the enrollment period who were eligible to enter the SCAMP, of whom 97 patients were entered into the pathway. Patients were risk

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2016 Critical Pathways in Cardiology

13. hs-Troponin I Followed by CT Angiography Improves Acute Coronary Syndrome Risk Stratification Accuracy and Work-Up in Acute Chest Pain Patients: Results From ROMICAT II Trial. (PubMed)

hs-Troponin I Followed by CT Angiography Improves Acute Coronary Syndrome Risk Stratification Accuracy and Work-Up in Acute Chest Pain Patients: Results From ROMICAT II Trial. This study compared diagnostic accuracy of conventional troponin/traditional coronary artery disease (CAD) assessment and highly sensitive troponin (hsTn) I/advanced CAD assessment for acute coronary syndrome (ACS) during the index hospitalization.hsTnI and advanced assessment of CAD using coronary computed tomography (...) [CI]: 0.80 to .88 vs. 0.74, 95% CI: 0.70 to 0.78; p < 0.001).hsTnI at the time of presentation followed by early advanced coronary CTA assessment improves the risk stratification and diagnostic accuracy for ACS as compared to conventional troponin and traditional coronary CTA assessment. (Multicenter Study to Rule Out Myocardial Infarction/Ischemia by Cardiac Computed Tomography [ROMICAT-II]; NCT01084239).Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All

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2015 JACC. Cardiovascular imaging

14. Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin (PubMed)

Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin Dual imaging stress echocardiography, combining the evaluation of wall motion and coronary flow reserve (CFR) on the left anterior descending artery (LAD), and computed tomography coronary angiography (CTCA) are established techniques for assessing prognosis in chest pain patients. In this study we compared the prognostic value of the two (...) methods in a cohort of patients with chest pain having suspected coronary artery disease (CAD).A total of 131 patients (76 men; age 68 ± 9 years) with chest pain of unknown origin underwent dipyridamole (up to 0.84 mg/kg over 6 min) stress echo with CFR assessment of LAD by Doppler and CTCA. A CFR ≤ 1.9 was considered abnormal, while > 50% lumen diameter reduction was the criterion for significant CAD at CTCA.Of 131 patients, 34 (26%) had ischemia at stress echo (new wall motion abnormalities), and 56

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2015 Cardiovascular ultrasound

15. Chest Pain Suggestive of Acute Coronary Syndrome

the patient’s postdischarge care altogether. It is not uncommon for a patient to have acute chest pain occurring from other cardiovascular causes or noncardiac etiologies. Patients may have predisposing cardiac risk factors and pain characteristics that place them in the triage category of intermediate probability for coronary artery disease (CAD). Further cardiac risk stratification of this subgroup of patients is recommended before discharge, and noninvasive imaging is often necessary to exclude ischemia (...) approach may be considered [5]. In patients with active chest pain, an ECG with no ischemic changes, and an initial negative troponin, rest single-photon emission computed tomography (SPECT) has been demonstrated to be useful [6,7]. However, it has been shown to be less sensitive than stress SPECT imaging if the chest pain has subsided. Stress echocardiography may be equally considered in acute chest pain patients as well. Noninvasive imaging may be indicated for risk stratification before discharge

2014 American College of Radiology

16. Addition of heart score to high-sensitivity troponin T versus conventional troponin T in risk stratification of patients with chest pain at the coronary emergency rooms (PubMed)

Addition of heart score to high-sensitivity troponin T versus conventional troponin T in risk stratification of patients with chest pain at the coronary emergency rooms Patients with chest pain have a large impact on available resources in coronary emergency rooms (CER). Clinical judgement, ECG, risk scores and biomarkers guide in risk stratification. We investigated if high-sensitivity troponin T (HsT) and the HEART Score could contribute to risk stratification at the CER. All patients (...) with chest pain, without elevated conventional troponin levels at presentation, were included. HsT levels were determined at admission (T1), at 4-6 h (T2) and 8-10 h after symptom onset (T3). The HEART Score was calculated as risk score for the occurrence of a major adverse cardiac event (MACE). Thirty days after discharge, occurrence of MACE was registered. Eighty-nine patients were included (overall mean age 61 years (range 20-90)). At presentation, 68 patients (76 %) had a HsT below cut-off value

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2014 Netherlands Heart Journal

17. Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes (HE-MACS) decision aid. (PubMed)

Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes (HE-MACS) decision aid. Several decision aids can 'rule in' and 'rule out' acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive (...) and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG.We undertook secondary analyses in three prospective diagnostic accuracy studies that included patients presenting to the ED with suspected cardiac chest pain. Clinicians recorded clinical features at the time of arrival using a bespoke form. Patients underwent serial troponin sampling and 30-day follow-up for the primary outcome of ACS. The model was derived by logistic

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2018 European Journal of Emergency Medicine

18. Novel Risk Stratification Assays for Acute Coronary Syndrome (PubMed)

Novel Risk Stratification Assays for Acute Coronary Syndrome Since identification of aspartate aminotransferase as the first cardiac biomarker in the 1950s, there have been a number of new markers used for myocardial damage detection over the decades. There have also been several generations of troponin assays, each with progressively increasing sensitivity for troponin detection. Accordingly, the "standard of care" for myocardial damage detection continues to change. The purpose of this paper (...) only one or two serial measurements. Recent algorithms utilizing these assays have allowed for more rapid rule-out of myocardial infarction in emergency department settings. In this review, we discuss novel assays available for the risk assessment of subjects presenting with chest pain, including both the "next generation" cardiac troponin assays as well as other novel biomarkers. We review the biological mechanisms for these markers, and explore the positive and negative predictive value

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2017 Current cardiology reports

19. MR-proANP and MR-proADM for risk stratification of patients with acute chest pain (PubMed)

MR-proANP and MR-proADM for risk stratification of patients with acute chest pain To evaluate mid-regional pro-adrenomedullin (MR-proADM) and mid-regional pro-atrial natriuretic peptide (MR-proANP) as prognostic biomarkers in a representative 'real world' cohort of patients with suspected acute coronary syndrome (ACS).Prospective observational multicentre cohort study.Chest pain units of three major hospitals in Germany from 2007 to 2008.Patients presenting with signs and symptoms suggestive (...) result in significant reclassification of patients when added to the Global Registry of Acute Coronary Events risk score, with an overall net reclassification improvement of 41.2% for MR-proADM and 35.7% for MR-proANP.MR-proADM and MR-proANP are predictors of future cardiovascular events in patients presenting with acute chest pain and might facilitate the choice of treatment in those patients complementary to established risk scores.

2013 EvidenceUpdates

20. A 2-hour thrombolysis in myocardial infarction score outperforms other risk stratification tools in patients presenting with possible acute coronary syndromes: Comparison of chest pain risk stratification tools. (PubMed)

A 2-hour thrombolysis in myocardial infarction score outperforms other risk stratification tools in patients presenting with possible acute coronary syndromes: Comparison of chest pain risk stratification tools. Accelerated diagnostic pathways for risk stratification of patients presenting to the emergency department with potential acute coronary syndromes may identify very-low-risk patients safe for early discharge to outpatient care.Patients presenting with potential acute coronary syndrome (...) to the emergency department were prospectively enrolled between November 2007 and April 2010. Patient characteristics in conjunction with 0- and 2-hour biomarkers and electrocardiograms were analyzed according to a 2-hour thrombolysis in myocardial infarction (TIMI) score and 9 other accelerated diagnostic pathways. The primary outcome was acute coronary syndrome by 30 days.Of 1,000 patients, 362 (36.2%) had a primary outcome. A pathway comprising electrocardiogram, prior ischemic heart disease, 0/2-hour

2012 American Heart Journal

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