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Coronary Risk Stratification of Chest Pain

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1. Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients: An African American urban community based hospit Full Text available with Trip Pro

Predictive risk stratification using HEART (history, electrocardiogram, age, risk factors, and initial troponin) and TIMI (thrombolysis in myocardial infarction) scores in non-high risk chest pain patients: An African American urban community based hospit Validated risk scoring systems in African American (AA) population are under studied. We utilized history, electrocardiogram, age, risk factors, and initial troponin (HEART) and thrombolysis in myocardial infarction (TIMI) scores to predict (...) major adverse cardiovascular events (MACE) in non-high cardiovascular (CV) risk predominantly AA patient population.A retrospective emergency department (ED) charts review of 1266 chest pain patients where HEART and TIMI scores were calculated for each patient. Logistic regression model was computed to predict 6-week and 1-year MACE and 90-day cardiac readmission. Decision curve analysis (DCA) was constructed to differentiate between clinical strategies in non-high CV risk patients.Of the 817

2019 Medicine

2. Risk stratification and role for additional diagnostic testing in patients with acute chest pain and normal high-sensitivity cardiac troponin levels. Full Text available with Trip Pro

Risk stratification and role for additional diagnostic testing in patients with acute chest pain and normal high-sensitivity cardiac troponin levels. Normal high sensitivity cardiac troponin (hs-cTn) assays rule out acute myocardial infarction (AMI) with great accuracy, but additional non-invasive testing is frequently ordered. This observational study evaluates whether clinical characteristics can contribute to risk stratification and could guide referral for additional testing.918 serial (...) patients with acute chest pain and normal hs-cTnT levels were prospectively included. Major adverse cardiac events (MACE) and non-invasive test results were assessed during one-year follow-up. Patients were classified as low and high risk based on clinical characteristics.MACE occurred in 6.1% of patients and mainly comprised revascularizations (86%). A recent abnormal stress test, suspicious history, a positive family history and higher baseline hs-cTnT levels were independent predictors of MACE

2018 PLoS ONE

3. Identification of coronary artery calcification can optimize risk stratification in patients with acute chest pain. Full Text available with Trip Pro

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

4. Chest Pain – Possible Acute Coronary Syndrome

likelihood for coronary artery disease, in the absence of cardiac enzyme elevation and ischemic ST changes. ??? X-ray chest 5 This procedure is primarily a survey for noncardiac etiologies of chest pain. ? CT chest with IV contrast 5 This procedure is primarily for noncardiac etiologies such as pulmonary embolism and aortic dissection. ??? MRI heart function with stress without and with IV contrast 5 For this procedure there is limited experience in the clinical setting and lack of availability. O MRI (...) 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

2019 American College of Radiology

5. 3 for the Price of 1: Teaching Chest Pain Risk Stratification in a Multidisciplinary, Problem-based Learning Workshop Full Text available with Trip Pro

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

2018 Western Journal of Emergency Medicine

6. 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

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

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 (...) elevation: a multicenter study. Am Heart J 2004;148:129-36. 52. Metz LD, Beattie M, Hom R, Redberg RF, Grady D, Fleischmann KE. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol 2007;49:227-37. 53. Ciampi Q, Rigo F, Grolla E, Picano E, Cortigiani L. Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin. Cardiovasc

2018 American College of Radiology

8. 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 Full Text available with Trip Pro

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 (...) to the Emergency Department of Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia, for 6 months from January to June 2016. All patients, included through non-probability convenience sampling, were assessed using standard protocols for the physiological parameters of the REMS, and ACS was confirmed through electrocardiography, cardiac enzyme testing, and angiography (if needed). Data were analyzed using Statistical Package for Social Sciences software version 15 (SPSS Inc, Chicago, IL, USA

2017 Saudi medical journal

9. Negative B natriuretic peptide testing confirms low risk stratification for patients with a definite pulmonary embolus.

: Manchester Royal Infirmary Current web editor: Daniel Horner - Critical Care SHO Date Submitted: 27th January 2009 Date Completed: 17th June 2015 Last Modified: 17th June 2015 Status: Green (complete) Three Part Question In [patients with definite pulmonary embolus] can a [low/negative BNP/NT-proBNP result] predict [low risk of death / adverse outcome?] Clinical Scenario A patient presents with a few days history of pleuritic chest pain. All clinical findings and investigations are normal except (...) Negative B natriuretic peptide testing confirms low risk stratification for patients with a definite pulmonary embolus. BestBets: Negative B natriuretic peptide testing confirms low risk stratification for patients with a definite pulmonary embolus. Negative B natriuretic peptide testing confirms low risk stratification for patients with a definite pulmonary embolus. Report By: Craig Ferguson - Consultant in Emergency Medicine Search checked by Daniel Horner - ST7 Emergency Medicine Institution

2015 BestBETS

10. 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. (Abstract)

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

11. Non-contrast Cardiac CT as a Risk Stratification Tool in Patients With Non-cardiac Chest Pain

commences at September 2014 and results of this project are expected to contribute to the risk stratification of Non-cardiac chest pain patients. Condition or disease Intervention/treatment Coronary Artery Disease Other: Non-contrast Cardiac CT scan Study Design Go to Layout table for study information Study Type : Observational Actual Enrollment : 248 participants Observational Model: Cohort Time Perspective: Prospective Study Start Date : September 2014 Actual Primary Completion Date : June 2015 (...) Non-contrast Cardiac CT as a Risk Stratification Tool in Patients With Non-cardiac Chest Pain Non-contrast Cardiac CT as a Risk Stratification Tool in Patients With Non-cardiac Chest Pain - 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

2015 Clinical Trials

12. Chest Pain Risk Stratification: A Comparison of the 2-Hour Accelerated Diagnostic Protocol (ADAPT) and the HEART Pathway. Full Text available with Trip Pro

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.

2016 Critical Pathways in Cardiology Controlled trial quality: uncertain

13. A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain Full Text available with Trip Pro

A novel cardiovascular risk stratification model incorporating ECG and heart rate variability for patients presenting to the emergency department with chest pain Risk stratification models can be employed at the emergency department (ED) to evaluate patient prognosis and guide choice of treatment. We derived and validated a new cardiovascular risk stratification model comprising vital signs, heart rate variability (HRV) parameters, and demographic and electrocardiogram (ECG) variables.We (...) conducted a single-center, observational cohort study of patients presenting to the ED with chest pain. All patients above 21 years of age and in sinus rhythm were eligible. ECGs were collected and evaluated for 12-lead ECG abnormalities. Routine monitoring ECG data were processed to obtain HRV parameters. Vital signs and demographic data were obtained from electronic medical records. Thirty-day major adverse cardiac events (MACE) were the primary endpoint, including death, acute myocardial infarction

2016 Critical Care

14. 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

15. Diagnosis, Risk Stratification, and Management of Pulmonary Hypertension of Sickle Cell Disease: An Official ATS Clinical Practice Guideline

Diagnosis, Risk Stratification, and Management of Pulmonary Hypertension of Sickle Cell Disease: An Official ATS Clinical Practice Guideline AMERICANTHORACICSOCIETY DOCUMENTS AnOf?cialAmericanThoracicSocietyClinicalPracticeGuideline: Diagnosis,RiskStrati?cation,andManagementofPulmonary HypertensionofSickleCellDisease Elizabeth S. Klings*, Roberto F. Machado*, Robyn J. Barst † , Claudia R. Morris, Kamal K. Mubarak, Victor R. Gordeuk, Gregory J. Kato, Kenneth I. Ataga, J. Simon Gibbs, Oswaldo (...) (PH) and right heart failure are well-established risk factors for mortality in sickle cell disease (SCD). Observational studies have consistently shown that increased tricuspid regurgitant jet velocity (TRV) measured by Doppler echocardiography, an increased serum N-terminal pro–brain natriuretic peptide (NT-pro-BNP) level, and pulmonary hypertension measured by right heart catheterization are all independent risk factors for mortality in adults. To reduce the variability and to improve

2014 American Thoracic Society

16. 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. Full Text available with Trip Pro

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

2015 JACC. Cardiovascular imaging Controlled trial quality: uncertain

17. Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. Full Text available with Trip Pro

Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. Fast and accurate chest pain risk stratification in the emergency department (ED) is critical. The HEART score predicts the short-term incidence of major adverse cardiac events (MACE) in this population, dividing it in three risk categories. We aimed to describe the population with chest pain, to characterize the subgroup of patients with acute coronary syndrome (ACS) and to assess (...) (c-statistic 0.880; 95 % CI, 0.807-0.950, p < 0.001).Chest pain patients have very different levels of severity and the discriminatory power of Manchester triage system should be used in the assessment of this population. The HEART score seems to be an effective tool for risk stratification in the ED.

2015 BMC Cardiovascular Disorders

18. Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin Full Text available with Trip Pro

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

2015 Cardiovascular ultrasound

19. Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes (HE-MACS) decision aid. Full Text available with Trip Pro

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

2018 European Journal of Emergency Medicine

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

of CAD 69. Yerramasu A, Lahiri A, Venuraju S, et al. Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. Eur Heart J Cardiovasc Imaging. 2014;15(8):886-892. 70. Shaw LJ, Raggi P, Schisterman E, Berman DS, Callister TQ. Prognostic value of cardiac risk factors and coronary artery calcium screening for all-cause mortality. Radiology. 2003;228(3):826-833. 71. Kim YJ, Hur J, Lee HJ, et al. Meaning of zero coronary calcium score (...) ultrasound [US]). Chest radiography The chest radiograph is an inexpensive test that can rapidly demonstrate many noncardiac causes of chronic chest pain, including a variety of diseases of the mediastinum, pleura, or lung. It may also provide qualitative indirect information about LV function as reflected in cardiac size and pulmonary vascular patterns (eg, pulmonary venous hypertension) [5]. However, chest radiographs can neither establish nor exclude chronic ischemic heart disease. In addition

2016 American College of Radiology

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