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Coronary Risk Stratification of Chest Pain

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181. Noninvasive Coronary Artery Imaging

%, respectively) but poor PPVs (50% and 38%, respectively). The accuracy of MDCT was similar to nuclear stress imaging in this low-risk cohort. In Australia, there has been a recent publication utilizing DSCT in the evaluation of acute chest pain in 89 patients. 60 It was a prospective observational study with follow-up to 1 year. The result of the coronary CTA was not given to the treating team, and all patients underwent subsequent stress testing and standard care. Coronary CTA identified all patients (...) coronary angiography for chest pain. Am J Cardiol. 2009;104:498-500 39. Kreisz FP, Merlin T, Moss J, Atherton J, Hiller JE, Gericke CA. The pre-test risk stratified cost-effectiveness of 64-slice computed tomography coronary angiography in the detection of significant obstructive coronary artery disease in patients otherwise referred to invasive coronary angiography. Heart Lung Circ. 2009;18:200-207 40. Cheng V, Gutstein A, Wolak A, Suzuki Y, Dey D, Gransar H, Thomson LE, Hayes SW, Friedman JD, Berman

2010 Cardiac Society of Australia and New Zealand

182. Magnetic Nanoparticles System in Acute Coronary Syndrome

or heart failure with different mechanism) may increase clinical sensitivity and improve early risk stratification. The present study, a rapid IMR assay with multiple biomarkers is proposed and we will examine the performance of this new investigational IMR assays, comparison with current commercial assays. Condition or disease Acute Coronary Syndrome Detailed Description: To improve the sensitivity and specificity of immunoassay, the developing trends are to lower the detection threshold (...) the magnetic nanoparticles. Rapid diagnosis of acute coronary syndrome (ACS) is a clinical and operational priority in busy emergency departments (ED). Since ACS is associated with a significant mortality and morbidity, early and correct diagnosis is of great importance. Chest pain is a frequent symptom in medical emergency departments and distinguishing patients with ACS within the chest pain group is a diagnostic challenge. Cardiac enzymes (including CPK/CK-MB, troponins, myoglobulin

2014 Clinical Trials

183. THIRD NATIONAL REGISTRY OF ACUTE CORONARY SYNDROMES

in the emergency department, coronary care units, intensive care units, hospital and hemodynamic laboratories Criteria Inclusion Criteria: all patients with suspected ACS and will analyze risk factors, chest pain and electrocardiographic characteristics. Exclusion Criteria: Patients with secondary ischemia (anaemia, pulmonary thromboembolism, myocarditis) and type II infarction. Contacts and Locations Go to No Contacts or Locations Provided More Information Go to Layout table for additonal information (...) Coronary Syndromes Study Details Study Description Go to Brief Summary: The Registry pretends to identify stratification, diagnosis and treatment approaches in patients with Acute Coronary Syndrome (ACS) in community hospitals with tertiary hospitals to optimize resources and identify strategies to improve health care quality through the creation of clinical guidelines that serve for unify management and treatment methods with adherence to international guidelines which include suggestions

2014 Clinical Trials

184. Prognostic value of coronary computed tomography angiography in stroke patients. (Abstract)

Prognostic value of coronary computed tomography angiography in stroke patients. The predictive value of coronary computed tomography angiography (CCTA) in stroke patients has not yet been established. We investigated the prognostic value of coronary artery disease (CAD) detection by CCTA, and determined the incremental risk stratification benefit of CCTA findings as compared to coronary artery calcium scores (CACS) in ischemic stroke patients without chest pain.Among 914 consecutive ischemic (...) improved risk stratification beyond clinical risk factors and CACS (iAUC: 0.863 vs 0.752, p < 0.05).In ischemic stroke patients without chest pain, CCTA findings of CAD provide additional risk-discrimination over CACS.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

2014 Atherosclerosis

185. Sensitivity, Specificity, and Sex Differences in Symptoms Reported on the 13‐Item Acute Coronary Syndrome Checklist (Full text)

Sensitivity, Specificity, and Sex Differences in Symptoms Reported on the 13‐Item Acute Coronary Syndrome Checklist Clinical symptoms are part of the risk stratification approaches used in the emergency department (ED) to evaluate patients with suspected acute coronary syndromes (ACS). The objective of this study was to determine the sensitivity, specificity, and predictive value of 13 symptoms for a discharge diagnosis of ACS in women and men.The sample included 736 patients admitted to 4 (...) EDs with symptoms suggestive of ACS. Symptoms were assessed with the 13-item validated ACS Symptom Checklist. Mixed-effects logistic regression models were used to estimate sensitivity, specificity, and predictive value of each symptom for a diagnosis of ACS, adjusting for age, obesity, diabetes, and functional status. Patients were predominantly male (63%) and Caucasian (70.5%), with a mean age of 59.7±14.2 years. Chest pressure, chest discomfort, and chest pain demonstrated the highest

2014 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease PubMed abstract

186. B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina. (Full text)

B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina. Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS.We included 982 patients (...) consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses.119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors

2011 BMC Cardiovascular Disorders PubMed abstract

187. Coronary Artery Vasospasm (Overview)

Vasospasm Updated: Nov 14, 2018 Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Eric H Yang, MD Share Email Print Feedback Close Sections Sections Coronary Artery Vasospasm Overview Background Coronary artery vasospasm, or smooth muscle constriction of the coronary artery, is an important cause of chest pain syndromes that can lead to myocardial infarction (MI), ventricular arrhythmias, and sudden death. It also plays a key role in the development of atherosclerotic lesions. In 1959, Prinzmetal et al (...) described a syndrome of nonexertional chest pain with ST-segment elevation on electrocardiography (ECG). [ ] Unlike patients with typical angina, these patients characteristically had normal exercise tolerance, and their pain patterns tended to be cyclical, with most episodes occurring in the early morning hours without regard to cardiac workload. This syndrome became known as Prinzmetal or variant angina, and was believed to be due to vasospasm in coronary arteries without obstructive lesions

2014 eMedicine.com

188. Coronary Artery Atherosclerosis (Follow-up)

and Forrester Chest Pain Prediction Rule: For example, in patients with suspected CAD using the new criteria, if the PTP is < 15%, investigate other possible causes and consider a diagnosis of functional coronary disease; if the PTP is intermediate (eg, 15%-85%), send the patient for noninvasive testing; if the PTP is high (eg, >85%), a diagnosis of CAD is established, and patient risk stratification should follow In stable CAD, the functional impact of coronary lesions relative to their angiographic (...) prevention in women with heart disease: the Heart and Estrogen/progestin Replacement Study. Ann Intern Med . 2003 Jan 21. 138(2):81-9. . Pullen LC. Coronary CT Angiography Predicts Cardiovascular Risk. Medscape Medical News . Dec 6 2013. . Conti A, Poggioni C, Viviani G, Luzzi M, Vicidomini S, Zanobetti M, et al. Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram. Am J Emerg Med . 2012 Mar 16. . Paynter NP

2014 eMedicine.com

189. Coronary Artery Vasospasm (Treatment)

sublingual, topical, or intravenous (IV) nitrate therapy. Nitroglycerin administered by any route (intracoronary, IV, topical, or sublingual) effectively treats episodes of angina and myocardial ischemia within minutes, and long-acting nitrate preparations reduce the frequency of recurrent events. Until atherosclerotic coronary disease (a much more frequent cause of chest pain) is excluded, standard therapies, including antiplatelet or antithrombotic agents, statins, and beta blockers, may (...) Am Coll Cardiol . 2011 Jan 11. 57(2):147-52. . Takagi Y, Takahashi J, Yasuda S, et al. Prognostic stratification of patients with vasospastic angina: a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association. J Am Coll Cardiol . 2013 Sep 24. 62(13):1144-53. . Kobayashi N, Hata N, Shimura T, et al. Characteristics of patients with cardiac arrest caused by coronary vasospasm. Circ J . 2013. 77(3):673-8. . Hendriks ML, Allaart CP, Bronzwaer JG, Res JJ, de Cock CC

2014 eMedicine.com

190. Coronary Artery Atherosclerosis (Treatment)

and Forrester Chest Pain Prediction Rule: For example, in patients with suspected CAD using the new criteria, if the PTP is < 15%, investigate other possible causes and consider a diagnosis of functional coronary disease; if the PTP is intermediate (eg, 15%-85%), send the patient for noninvasive testing; if the PTP is high (eg, >85%), a diagnosis of CAD is established, and patient risk stratification should follow In stable CAD, the functional impact of coronary lesions relative to their angiographic (...) prevention in women with heart disease: the Heart and Estrogen/progestin Replacement Study. Ann Intern Med . 2003 Jan 21. 138(2):81-9. . Pullen LC. Coronary CT Angiography Predicts Cardiovascular Risk. Medscape Medical News . Dec 6 2013. . Conti A, Poggioni C, Viviani G, Luzzi M, Vicidomini S, Zanobetti M, et al. Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram. Am J Emerg Med . 2012 Mar 16. . Paynter NP

2014 eMedicine.com

191. Coronary Artery Vasospasm (Diagnosis)

Vasospasm Updated: Nov 14, 2018 Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Eric H Yang, MD Share Email Print Feedback Close Sections Sections Coronary Artery Vasospasm Overview Background Coronary artery vasospasm, or smooth muscle constriction of the coronary artery, is an important cause of chest pain syndromes that can lead to myocardial infarction (MI), ventricular arrhythmias, and sudden death. It also plays a key role in the development of atherosclerotic lesions. In 1959, Prinzmetal et al (...) described a syndrome of nonexertional chest pain with ST-segment elevation on electrocardiography (ECG). [ ] Unlike patients with typical angina, these patients characteristically had normal exercise tolerance, and their pain patterns tended to be cyclical, with most episodes occurring in the early morning hours without regard to cardiac workload. This syndrome became known as Prinzmetal or variant angina, and was believed to be due to vasospasm in coronary arteries without obstructive lesions

2014 eMedicine.com

192. Acute Coronary Syndrome (Follow-up)

of Gp IIb/IIIa blockers followed by early invasive catheterization is the most logical approach. An early invasive strategy should be considered in patients with large myocardial infarction, hypotension, shock, RV infarction, and refractory chest pain. In the Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial, an early invasive strategy had no apparent long-term benefit in reducing death or myocardial infarction. After stratification for risk, analysis of 5-year (...) . . . Gardner LS, Nguyen-Pham S, Greenslade JH, et al. Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. Emerg Med J . 2014 Oct 24. . Boggs W. Blood glucose predicts outcomes of patients with chest pain. Reuters Health Information . November 11, 2014. . Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary

2014 eMedicine Emergency Medicine

193. Coronary Artery Vasospasm (Follow-up)

sublingual, topical, or intravenous (IV) nitrate therapy. Nitroglycerin administered by any route (intracoronary, IV, topical, or sublingual) effectively treats episodes of angina and myocardial ischemia within minutes, and long-acting nitrate preparations reduce the frequency of recurrent events. Until atherosclerotic coronary disease (a much more frequent cause of chest pain) is excluded, standard therapies, including antiplatelet or antithrombotic agents, statins, and beta blockers, may (...) Am Coll Cardiol . 2011 Jan 11. 57(2):147-52. . Takagi Y, Takahashi J, Yasuda S, et al. Prognostic stratification of patients with vasospastic angina: a comprehensive clinical risk score developed by the Japanese Coronary Spasm Association. J Am Coll Cardiol . 2013 Sep 24. 62(13):1144-53. . Kobayashi N, Hata N, Shimura T, et al. Characteristics of patients with cardiac arrest caused by coronary vasospasm. Circ J . 2013. 77(3):673-8. . Hendriks ML, Allaart CP, Bronzwaer JG, Res JJ, de Cock CC

2014 eMedicine.com

194. Acute Coronary Syndrome (Diagnosis)

. . . Gardner LS, Nguyen-Pham S, Greenslade JH, et al. Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. Emerg Med J . 2014 Oct 24. . Boggs W. Blood glucose predicts outcomes of patients with chest pain. Reuters Health Information . November 11, 2014. . Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary (...) ) Current guidelines for patients with moderate- or high-risk ACS include the following: Early invasive approach Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or LMWH See and for more detail. The image below depicts a 62-year-old woman with a history of chronic stable angina and a "valve problem." A 62-year-old woman with a history of chronic stable angina and a "valve problem" presents with new chest pain. She is symptomatic on arrival, complaining of shortness

2014 eMedicine Emergency Medicine

195. Acute Coronary Syndrome (Overview)

. . . Gardner LS, Nguyen-Pham S, Greenslade JH, et al. Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. Emerg Med J . 2014 Oct 24. . Boggs W. Blood glucose predicts outcomes of patients with chest pain. Reuters Health Information . November 11, 2014. . Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary (...) ) Current guidelines for patients with moderate- or high-risk ACS include the following: Early invasive approach Concomitant antithrombotic therapy, including aspirin and clopidogrel, as well as UFH or LMWH See and for more detail. The image below depicts a 62-year-old woman with a history of chronic stable angina and a "valve problem." A 62-year-old woman with a history of chronic stable angina and a "valve problem" presents with new chest pain. She is symptomatic on arrival, complaining of shortness

2014 eMedicine Emergency Medicine

196. Acute Coronary Syndrome (Treatment)

of Gp IIb/IIIa blockers followed by early invasive catheterization is the most logical approach. An early invasive strategy should be considered in patients with large myocardial infarction, hypotension, shock, RV infarction, and refractory chest pain. In the Invasive Versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial, an early invasive strategy had no apparent long-term benefit in reducing death or myocardial infarction. After stratification for risk, analysis of 5-year (...) . . . Gardner LS, Nguyen-Pham S, Greenslade JH, et al. Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. Emerg Med J . 2014 Oct 24. . Boggs W. Blood glucose predicts outcomes of patients with chest pain. Reuters Health Information . November 11, 2014. . Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary

2014 eMedicine Emergency Medicine

197. Medium-term outcome after anomalous aortic origin of a coronary artery repair in a pediatric cohort. (Full text)

Medium-term outcome after anomalous aortic origin of a coronary artery repair in a pediatric cohort. Anomalous aortic origin of a coronary artery with an interarterial and intramural course (AAOCA) is a rare anomaly with increased risk of sudden cardiac death during or just after exercise among otherwise healthy youth. Risk stratification and management remain controversial, especially for the asymptomatic child with an anomalous right coronary artery from the left coronary sinus (ARCA). Medium (...) of cardiac-type symptoms postoperatively, most commonly chest pain, none correlating with evidence of ischemia on testing. Of the 13 patients, 7 (54%) reported the same symptoms preoperatively; and of these, 5 had ARCA. Postoperative morbidity occurred in 16 (67%), including pericardial effusion (n = 11), wound infection (n = 2), and development of mild aortic insufficiency (n = 4). QOL questionnaires were sent to 21 subjects; 12 (57%) were returned. Average QOL was normal for all subjects.In the medium

2013 Journal of Thoracic and Cardiovascular Surgery PubMed abstract

198. Diagnostic value of coronary artery calcium scoring in low-intermediate risk patients evaluated in the emergency department for acute coronary syndrome. (Abstract)

Diagnostic value of coronary artery calcium scoring in low-intermediate risk patients evaluated in the emergency department for acute coronary syndrome. Early and accurate triage of patients with possible ischemic chest pain remains challenging in the emergency department because current risk stratification techniques have significant cost and limited availability. The aim of this study was to determine the diagnostic value of the coronary artery calcium score (CACS) for the detection (...) of obstructive coronary artery disease (CAD) in low- to intermediate-risk patients evaluated in the emergency department for suspected acute coronary syndromes. A total of 225 patients presenting to the emergency department with acute chest pain and Thrombolysis In Myocardial Infarction (TIMI) scores <4 who underwent non-contrast- and contrast-enhanced coronary computed tomographic angiography were included. CACS was calculated from the noncontrast scan using the Agatston method. The prevalence

2011 American Journal of Cardiology

199. Prognostic Information of Glycogen Phosphorylase Isoenzyme BB in Patients With Suspected Acute Coronary Syndrome. (Abstract)

Prognostic Information of Glycogen Phosphorylase Isoenzyme BB in Patients With Suspected Acute Coronary Syndrome. Early and adequate risk stratification is essential in patients with suspected acute coronary syndrome (ACS). The aim of the present study was to investigate whether glycogen phosphorylase BB (GPBB) could add prognostic information in the context of contemporary sensitive troponin I determination and B-type natriuretic peptide (BNP). Patients with suspected ACS were consecutively (...) . In conclusion, GPBB measurement provides predictive information on midterm prognosis in patients with chest pain in addition to BNP and troponin I.Copyright © 2012 Elsevier Inc. All rights reserved.

2012 American Journal of Cardiology

200. Comparison of Cardiac Imaging Techniques for Diagnosing Coronary Artery Disease

modalities Secondary Outcome Measures : Risk stratification [ Time Frame: Ten years ] To determine the incremental prognostic value of several biomarkers over non-invasive imaging, clinical, historical and exercise test data to predict overall mortality, nonfatal myocardial infarction, revascularization and hospitalization for chest pain or heart failure. Risk stratification [ Time Frame: > 6 months ] To compare the predictive and incremental value of stand-alone and cardiac hybrid imaging imaging over (...) clinical, historical and exercise test data for the prediction of a composite endpoint including cardiac death, nonfatal myocardial infarction, late referral to revascularization, or late hospitalization for chest pain or heart failure. Risk stratification [ Time Frame: > 6 months ] To compare the predictive and incremental value of several biomarkers over non-invasive imaging, clinical, historical and exercise test data for the prediction of a composite endpoint including cardiac death, nonfatal

2012 Clinical Trials

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