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Coronary Risk Stratification of Chest Pain

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181. 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

182. 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

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

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

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

184. 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

185. 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

186. 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

187. 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

188. 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

189. 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

190. 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

191. 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

192. 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

193. 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

194. Cardiovascular Risk in Asymptomatic Adults: Guideline For Assessment of

. GENERAL DESCRIPTION AND BACKGROUND e82 2.6.1.3. ELECTROCARDIOGRAPHIC STRESS TESTING FOR SILENT MYOCARDIAL ISCHEMIA e83 2.6.1.4. NONINVASIVE STRESS IMAGING FOR DETECTION OF ISCHEMIA AND RISK STRATIFICATION e83 2.6.1.5. USEFULNESS IN MOTIVATING PATIENTS e83 2.6.1.6. EVIDENCE OF VALUE FOR RISK ASSESSMENT FOR CORONARY ATHEROSCLEROSIS OR ISCHEMIA OR BOTH TO GUIDE THERAPY OR CHANGE PATIENT OUTCOMES e83 2.6.1.7. DIABETES AND HEMOGLOBIN A1C e83 2.6.1.8. ASSOCIATION WITH CARDIOVASCULAR RISK e84 2.6.1.9 (...) Risk Factors e59 2.2. Family History and Genomics e60 2.2.1. Recommendation for Family History e60 2.2.1.1. ASSOCIATIONWITHINCREASEDCARDIOVASCULAR RISK AND INCREMENTAL RISK e60 2.2.1.2. USEFULNESS IN MOTIVATING PATIENTS OR GUIDING THERAPY e60 2.2.2. Genotypes: Common Genetic Variants for Coronary Heart Disease e61 2.2.2.1. RECOMMENDATION FOR GENOMIC TESTING e61 2.2.2.2. ASSOCIATIONWITHINCREASEDCARDIOVASCULAR RISK AND INCREMENTAL RISK e61 2.2.2.3. USEFULNESS IN MOTIVATING PATIENTS OR GUIDING THERAPY

2010 American College of Cardiology

195. Class Act: Cardiac CT to Assess Coronary Artery Calcium

al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation. 2007;115(3):402-426. 9. Oudkerk M, Stillman AE, Halliburton SS, et al. Coronary (...) worldwide. Despite our understanding of how family history, toxic habits, cholesterol, and blood pressure affect the risk of myocardial infarction (MI), there is a clear need to further refine the methods of risk stratification. The Framingham Risk Score (FRS) is an excellent in-office tool that can be used to determine whether a patient is at low (<10%), intermediate (10%-20%), or high (>20%) 10-year risk for future coronary heart disease (CHD) events based on history and basic lab tests. Patients

2009 Clinical Correlations

196. Coronary CT Angiography in Acute Chest Pain is a Cost Effective Risk Stratification Strategy

Coronary CT Angiography in Acute Chest Pain is a Cost Effective Risk Stratification Strategy Coronary CT Angiography in Acute Chest Pain is a Cost Effective Risk Stratification Strategy - 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. Coronary CT Angiography in Acute Chest Pain is a Cost Effective Risk Stratification Strategy 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: NCT00825435 Recruitment Status : Unknown Verified January 2009 by University of Texas Southwestern Medical Center. Recruitment status

2009 Clinical Trials

197. CT-FIRST: Cardiac Computed Tomography Versus Stress Imaging For Initial Risk STratification

for coronary ischemia. Exercise treadmill testing is often selected as the initial diagnostic modality for coronary artery function. However, exercise treadmill testing is limited by its modest sensitivity and specificity, often resulting in further cardiac resource utilization for patient risk stratification and reassurance. Additionally, many patients with chest pain are not candidates for regular stress testing due to an abnormal baseline electrocardiogram or inability to exercise. Therefore, exercise (...) of using cardiac CT scans of the heart arteries to the stress test that their doctors ordered. Condition or disease Intervention/treatment Phase Coronary Artery Disease Chest Pain Coronary Atherosclerosis Stress Testing Procedure: Cardiac CT Angiography Procedure: Stress Imaging Test (Stress Myocardial Perfusion Study or Stress Echocardiogram) Not Applicable Detailed Description: The current evaluation for chest pain in low and intermediate risk patients typically starts with a functional assessment

2010 Clinical Trials

198. Medium-term outcome after anomalous aortic origin of a coronary artery repair in a pediatric cohort. (PubMed)

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

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2013 Journal of Thoracic and Cardiovascular Surgery

199. Excess of mortality in patients with chest pain peaks in the first 3 days period after the incident and normalizes after 1 month. (PubMed)

Excess of mortality in patients with chest pain peaks in the first 3 days period after the incident and normalizes after 1 month. patients presenting with chest pain have a 5% chance of experiencing a coronary event. These patients are at risk of mortality and should be recognized and referred to secondary care. Aim. To determine the relationship between referral type and mortality in patients with chest pain.the design of the study is an observational study. The setting of the study (...) . There is a marked trend in mortality according to the referral type-urgently referred, non-urgently referred and not referred-suggesting risk stratification by the GP. After 1 month, mortality normalizes for all groups, suggesting that the surviving patients are well treated and the condition causing the chest pain no longer influences survival compared to the general population.

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2010 Family Practice

200. Emergency department and office-based evaluation of patients with chest pain. (PubMed)

and transitioned to further outpatient evaluation or chest pain units. Multiple imaging strategies have been investigated to accelerate diagnosis and to provide further risk stratification of patients with no initial evidence of ACS. These include rest myocardial perfusion imaging, rest echocardiography, computed tomographic coronary angiography, and cardiac magnetic resonance imaging. All have very high negative predictive values for excluding ACS and have been successful in reducing unnecessary admissions (...) for patients at low to intermediate risk of ACS. As patients with acute chest pain transition from the evaluation in the emergency department to other outpatient settings, it is important that all clinicians involved in the care of these patients understand the tools used for assessment and risk stratification.

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2010 Mayo Clinic Proceedings

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