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Coronary Risk Stratification of Chest Pain

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221. Risk stratification in patients with unstable angina using absolute serial changes of 3 high-sensitive troponin assays. (Abstract)

Risk stratification in patients with unstable angina using absolute serial changes of 3 high-sensitive troponin assays. It is unknown whether unstable angina (UA) results in previously nondetectable low-level myocardial necrosis. We compared the pattern of myocardial necrosis between patients with UA, acute myocardial infarction (AMI), and noncardiac chest pain (NCCP) using 3 high-sensitive cardiac troponin (hs-cTn) assays.In a multicenter study, we enrolled 842 unselected patients with acute (...) chest pain in the emergency department. Roche hs-cTnT, Beckman Coulter hs-cTnI, and Siemens hs-cTnI were determined in a blinded fashion at presentation and after 1, 2, 3, and 6 hours. The final diagnosis was adjudicated by 2 independent cardiologists.A change in hs-cTn of ≥2 ng/L within the first hour after presentation as assessed with Roche hs-cTnT, Beckman Coulter hs-cTnI, and Siemens hs-cTnI was observed in 26%, 31%, and 32% of patients with UA (n = 115) compared with 91%, 92%, and 96

2013 American Heart Journal

222. Pharmacological Management of Cancer Pain in Adults

for converting opioids 105 Table 12 Opioid Equivalence Summary Table 106 Table 13 Classification of Chronic Kidney Disease 132 Table 14 Risk stratification of opioids 138 Table 15 Dosage recommendations for opioids in patients with renal impairment 140 Table 16 The Effects of Liver Disease on Opioid Pharmacokinetics 146 Table 17 Recommendations on the use of analgesics in liver disease 147 Table 18 AGREE II scores 159 Table 19 Recommendation matrix 160 Table 20 Respondents to the consultation process 256 (...) Pharmacological Management of Cancer Pain in Adults Pharmacological Management of Cancer Pain in Adults National Clinical Guideline No. 9 November 2015Guideline Development Group The Pharmacological Management of Cancer Pain in Adults Guideline was developed by a subgroup of the Health Service Executive (HSE)/Royal College of Physicians (RCPI) National Clinical Programme for Palliative Care. The Core Guideline Development Group was supported by a group of senior multidisciplinary service leads

2015 National Clinical Guidelines (Ireland)

223. Chronic Pelvic Pain

of pain 55 8.3 Psychological issues in the treatment of pain 55 8.4 Female pelvic pain 56 8.4.1 Psychological risk factors in development and maintenance of pelvic pain 56 8.4.2 Psychological factors in treatment of persistent pelvic pain 56 8.5 Conclusions and recommendations: psychological aspects of CPP 57 9. PELVIC FLOOR FUNCTION AND CHRONIC PELVIC PAIN 58 9.1 Introduction 58 9.2 Function 58 9.3 Dysfunction 58 9.4 Pelvic floor muscles and myofascial pain 58 9.4.1 Muscular aspects 59 9.4.2 (...) of the spinal, abdominal or pelvic complex of muscles. It is not unknown for adjacent muscles of the lower limbs and the thorax to become involved. Pain may be localised to the trigger points but it is more often associated with classical referral patterns. As well as trigger points, inflammation of the attachments to the bones (enthesitis) and of the bursa (bursitis) may be found [31]. Certain postures affect the different muscles in different ways, and as a consequence, may exacerbate or reduce the pain

2015 European Association of Urology

224. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

intracellular prostacyclin synthesis, which eventually impairs the release of tissue-type plasminogen activator. As chronic pain frequently coexists with mental stress, characterized by a hypercoagulable state, patients with chronic pain may be placed at an increased risk for coronary or cerebrovascular events after discontinuation of protective antiplatelet and anticoagulant medications. This underscores the importance of coordinating the perioperative handling of these medications with the prescribing (...) trial. | Summary recommendation for non–aspirin NSAIDs Non–aspirin NSAIDs are used for pain control and, unlike aspirin, are not required for cardiac and cerebral protection. Therefore, these drugs may be discontinued without negatively affecting cardiac and cerebral function. For interventional pain procedures where the bleeding risks and consequences of hematoma development may be higher (eg, high-risk procedures; ), consideration should be given to discontinue these medications. Besides ibuprofen

2015 American Society of Regional Anesthesia and Pain Medicine

225. Acute Pain Management: Scientific Evidence

of the intercostobrachial nerve during mastectomy does not decrease chest wall hypersensitivity ( N) (Level I [PRISMA]). 5. Cryoanalgesia of the intercostal nerves at the time of thoracotomy results in no improvement in acute pain but an increase in chronic pain (S) (Level I). 6. There is significant association between anxiety, pain catastrophising ( N) (Level III-2 SR), depression, psychological vulnerability and stress (N) (Level IV SR) and the subsequent development of chronic postsurgical pain. 7. Other risk (...) understanding of mechanisms that explain how acute pain can often lead to chronic pain (Gilron 2014; Shipton 2014b). Most patients will recover and return to their normal life after an acute injury or surgery, yet others will suffer chronic pain and long-lasting disabilities ( Lavand’homme 2011). There are many short-term and long-term consequences of inadequately treated acute pain. These include hyperglycaemia, insulin resistance, an increased risk of infection, decreased patient comfort and satisfaction

2015 Clinical Practice Guidelines Portal

226. Combination Therapy for Pulmonary Arterial Hypertension A Review of the Clinical Effectiveness

by progressive increase in pulmonary vascular resistance which leads to right heart failure and premature death. 1 The pathology includes pulmonary artery vasoconstriction, smooth muscle cell and endothelial cell proliferation, and pulmonary thrombosis. Symptoms of PAH, such as breathlessness, fatigue, chest pain, fainting and edema, worsen as the disease progresses. 1 PAH may be classified as idiopathic, or familial, or may be associated with the following: connective tissue disease, congenital systemic (...) with pulmonary arterial hypertension. J Heart Lung Transplant. 2011 Jun;30(6):632-43. 3. Galiè N, Brundage BH, Ghofrani HA, Oudiz RJ, Simonneau G, Safdar Z, et al. Tadalafil therapy for pulmonary arterial hypertension. Circulation [Internet]. 2009 Jun 9 [cited 2011 Nov 16];119(22):2894-903. Available from: http://circ.ahajournals.org/content/119/22/2894.full.pdf+html 4. Galiè N, Rubin L, Hoeper M, Jansa P, Al-Hiti H, Meyer G, et al. Treatment of patients with mildly symptomatic pulmonary arterial

2012 Canadian Agency for Drugs and Technologies in Health - Rapid Review

227. Coronary atherosclerosis imaging by CT to improve clinical outcomes. Full Text available with Trip Pro

of outcomes after CCTA in patients with acute chest pain and asymptomatic patients. In addition, more advanced quantification of plaque subtypes, vascular inflammation and coronary flow dynamics may identify further patients at increased risk.Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved. (...) Coronary atherosclerosis imaging by CT to improve clinical outcomes. Coronary artery disease remains an important cause of morbidity and mortality world-wide. Coronary Computed Tomography Angiography (CCTA) has excellent diagnostic accuracy and the identification and stratification of coronary artery disease is associated with improved prognosis in multiple studies. Recent randomized controlled trials have shown that in patients with stable coronary artery disease, CCTA is associated

2019 Journal of cardiovascular computed tomography

228. Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke. Full Text available with Trip Pro

patients without cardiac symptoms.From January 2013 to December 2014, 762 ischemic stroke patients with risk factors for CAD and without chest pain underwent coronary computed tomography angiography. CACS, CAD extent classification, and CAD-RADS scores were used to evaluate the computed tomography angiography images. The primary endpoint was major adverse cardiovascular events (MACEs), which were defined as cardiovascular death, nonfatal myocardial infarction, unstable angina requiring hospitalization (...) Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke. The coronary artery disease-reporting and data system (CAD-RADS) was recently developed to standardize CAD classifications and incorporate clinical management. We aimed to investigate the prognostic value and additional risk stratification benefits of CAD-RADS compared to coronary artery calcium scores (CACS) and CAD extent classifications in ischemic stroke

2019 Atherosclerosis

229. Microcirculation function assessed by adenosine triphosphate stress myocardial contrast echocardiography and prognosis in patients with nonobstructive coronary artery disease. Full Text available with Trip Pro

with nonobstructive coronary artery disease (CAD).From 2006 to 2014, 227 consecutive patients with chest pain and a diagnostic coronary angiography without significant coronary artery stenosis (<50%) who underwent adenosine triphosphate disodium (ATP) stress MCE were enrolled. Quantitative MCE measurements were analyzed using replenishment curves.Median follow-up time of this study was 5.3 years. Predictors of impaired coronary flow reserve (CFR) were smoking, diabetes, high apolipoprotein B, high low-density (...) [CI]: 3.01-182.32; P = .003), β reserve ≤1.6 (OR = 29.96, 95% CI: 3.5-241.27; P = .002), and diabetic (OR = 33.11, 95% CI: 3.65-300.02; P = .002) significantly increased the risk of the primary endpoint events.ATP stress quantitative MCE is a feasible and effective method to evaluate microcirculation abnormalities in human coronary arteries and it can be used for the clinical analysis, risk stratification, and treatment of early CAD.

2019 Medicine

230. Clinical Risk Score Predicting the Cardiac Rupture in Patients With ST-elevation Myocardial Infarction

Sponsor: Chinese PLA General Hospital Information provided by (Responsible Party): Qian geng, Chinese PLA General Hospital Study Details Study Description Go to Brief Summary: The purpose of this study is to validate a practical risk score to predict the mechanical complication of ST-elevation myocardial infarction (STEMI). Condition or disease Intervention/treatment Cardiac Rupture Other: Grouping by different risk stratification Detailed Description: STEMI patients chewed 300 mg aspirin and 600 mg (...) Score Predicting the Cardiac Rupture in Patients With ST-elevation Myocardial Infarction Study Start Date : January 2012 Actual Primary Completion Date : January 2015 Actual Study Completion Date : January 2015 Resource links provided by the National Library of Medicine related topics: resources: Groups and Cohorts Go to Intervention Details: Other: Grouping by different risk stratification A simple risk score system based on 7 baseline clinical variables divided patients into four groups Other Name

2015 Clinical Trials

231. Management of Stable Coronary Artery Disease

as having a low-risk acutecoronarysyn- drome (ACS) according to the current ACS guidelines of the ESC [no recurrence of chest pain, no signs of heart failure, no abnormalities in the resting electrocardiogram (ECG), no rise in markers of myocar- dial necrosis (preferably troponin) and hence are not candidates for swift intervention] 1 should also be managed according to the algo- rithms presented in these Guidelines. Although routine screening of asymptomatic patients is discouraged, 2 these guidelines (...) . . . . . . . . . . . . . . . . .2970 6.4.3.3 Stress perfusion scintigraphy (single photon emission computed tomography and positron emission tomography) .2971 6.4.3.4 Stress cardiac magnetic resonance . . . . . . . . . . .2971 6.4.4 Event risk strati?cation using coronary anatomy . . . .2971 6.4.4.1 Coronary computed tomography angiography . . .2971 6.4.4.2 Invasive coronary angiography . . . . . . . . . . . . . .2971 6.5 Diagnostic aspects in the asymptomatic individual without known coronary artery disease (see web addenda

2013 European Society of Cardiology

232. Management of Chronic Obstructive Pulmonary Disease (COPD)

the use of corticosteroids or antibiotics to treat COPD exacerbations. Non-pharmacologic interventions considered include pulmonary rehabilitation and interventions that comprise an overall disease management program for patients with COPD. This CPG also considers the use of oxygen therapy and the use of non-invasive ventilation (NIV). Additionally, this CPG considers the use of spirometry, symptom severity, risk of exacerbations, and comorbidities to diagnose, classify, and manage COPD. It also (...) of ten RCTs of heterogeneous interventions. [159] There is insufficient evidence that telehealth care for patients with COPD affects mortality, QoL, patient satisfaction, or health care costs. Pulmonary Rehabilitation The American Thoracic Society (ATS) and the European Respiratory Society (ERS) defines Pulmonary Rehabilitation as a “comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training

2014 VA/DoD Clinical Practice Guidelines

233. Study of the Prediction of Acute Kidney Injury in Children Using Risk Stratification and Biomarkers

the ability of potential therapeutic measures to be effective. The investigators' recent proposition of the renal angina construct aims to improve and expedite AKI diagnosis through use of risk stratification. An apt parallel is the profound outcome change that has been effected in acute coronary syndrome through targeted troponin measurements in patients with both risk factors and clinical symptoms of coronary ischemia. Novel AKI biomarkers will struggle to gain widespread use until their performance (...) relevant MeSH terms: Layout table for MeSH terms Wounds and Injuries Acute Kidney Injury Angina Pectoris Renal Insufficiency Kidney Diseases Urologic Diseases Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Chest Pain Pain Neurologic Manifestations Signs and Symptoms

2012 Clinical Trials

234. Reducing the Risk - Thrombosis and Embolism during Pregnancy and the Puerperium

D P DRCOG Green-top Guideline No. 37a © Royal College of Obstetricians and Gynaecologists 8 of 40 Warfarin Warfarin use in pregnancy is restricted to the few situations where heparin is considered unsuitable, e.g. some women with mechanical heart valves. Women receiving long-term anticoagulation with warfarin can be converted from LMWH to warfarin postpartum when the risk of haemorrhage is reduced, usually 5–7 days after delivery. Warfarin is safe in breastfeeding. Dextran Dextran should (...) . For the diagnosis and management of acute VTE in pregnancy, please refer to Green-top Guideline No. 37b. 1 For anticoagulation for mechanical heart valves in pregnancy, the reader is directed to the chapter covering this within the proceedings of the RCOG study group on heart disease. 2 A summary of the guideline for antenatal and postnatal thromboprophylaxis is given in Appendix I. 2. Introduction and background epidemiology Pulmonary embolism (PE) remains a leading direct cause of maternal death in the UK

2015 Royal College of Obstetricians and Gynaecologists

235. Characteristics and Outcomes of Patients Hospitalized With Suspected Acute Coronary Syndrome in Whom the Diagnosis is not Confirmed. (Abstract)

and compared this subgroup with true ACS patients. Of 2557 patients included, 9.0% were discharged with a non-ACS diagnosis such as nonspecific chest pain, myopericarditis, stress cardiomyopathy, hemodynamic disturbances, heart failure, myocardial, pulmonary or valvular disease, or others. Compared with true ACS patients, those with other diagnoses were younger, more often female, and had less cardiovascular risk factors. Both groups had comparable rates of nonchest pain presentation and similar (...) hemodynamic characteristics on admission. Non-ACS patients presented less often with Q waves or with ST-segment or T-wave changes and had a lower Global Registry of Acute Coronary Events score than true ACS patients. In-hospital (4.3 vs 4.0%, respectively, p = 0.834) and 6-month (5.4 vs 8.0%, respectively, p = 0.163) mortality rates were comparable in both groups. However, if patients in the non-ACS group were divided into subgroups with nonspecific chest pain (6.2% of total) or other diagnoses (2.8

2018 American Journal of Cardiology

236. Reliability of Cardiac Troponins for the Diagnosis of Myocardial Infarction in the Presence of Skeletal Muscle Disease

, this prospective cohort will document the role of these biomarkers in the diagnosis, prognosis and risk-stratification of the muscle disease. Patients will receive a 1- and 3-year follow-up visit with blood draw in order to measure cTn and other biomarkers and record the impact of the evolution and treatment of the muscle disease on these levels. Major adverse cardiac events including cardiovascular death, AMI, hospitalization for heart failure, and the development of clinical or subclinical heart failure (...) and their diagnostic and prognostic accuracy regarding a possible cardiac involvement) and in the field of neurology (for the detection and risk-stratification of the muscle disorder itself). Methodology: This study will be conducted at the University Hospital of Basel, at the Kantonsspital Aarau, both in Switzerland, and at the University Hospital of Innsbruck, Austria. A prospective cohort patient will be recruited through the neurology, rheumatology and cardiology clinics of these three hospitals

2018 Clinical Trials

237. A HEART Pathway pitfall in an admitted patient: A case report. Full Text available with Trip Pro

cardiac injury, it is plausible an initial troponin could still remain negative upon arrival. Extending the HEART Pathway to include a 3-hour delta troponin for admitted patients boarded in the emergency department may help alert the patient's inpatient team of those requiring more aggressive evaluations or more timely interventions. The case discussed herein highlights the course of a patient who was admitted to a medicine floor for chest pain along the HEART Pathway. After remaining in the ED (...) A HEART Pathway pitfall in an admitted patient: A case report. This paper discusses a possible weakness of the HEART Pathway specific to patients identified as high risk, requiring admission for inpatient risk stratification. Emergency Department (ED) crowding is at an all-time high and the possibility that many of these patients will board in the ED for a period of time before they are transported to an inpatient ward is becoming more likely. Given troponins peak at 6 h after the initial

2018 American Journal of Emergency Medicine

238. The PRECISE Protocol: Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization

using the PROMISE Risk Tool with functional and anatomic non-invasive evaluation with cCTA with selective FFRct can improve outcomes over usual care in stable chest pain patients while safely deferring further testing in low-risk patients and reducing cost overall Outcome Measures Go to Primary Outcome Measures : Composite of Death / MI / invasive coronary angiography without obstructive disease [ Time Frame: 1 year ] All cause death, non-fatal MI or invasive cardiac catheterization without (...) ) using a risk tool based on pretest clinical characteristics derived from the PROMISE trial and validated in SCOT-HEART trial. Participants assigned to guideline-recommended care without planned testing will be treated with preventive and antianginal medical treatment per guideline recommendations and clinical judgment and followed without testing. Diagnostic Test: cCTA with selective FFRct PRECISE will evaluate whether a precision evaluation strategy that combines contemporary risk stratification

2018 Clinical Trials

239. Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. (Abstract)

Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium (...) that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic

2018 Journal of cardiovascular computed tomography

240. Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease 2

lesions (ICA-QCA diameter stenosis). However, disagreement between FFR and QFR has been identified in up to 20% of all measurements. Acoustic detections of coronary stenosis from automatically recorded and analyzed heart sounds is a newly developed technology potentially useful for pre-test risk stratification before e.g. CCTA. One of these devices, the CADScor®System, has previously shown an area under the receiver operating characteristic curve (AUC of ROC) of 70-80% compared to conventional ICA-QCA (...) . This indicates that the CADScor®System could potentially supplement clinical assessment of CAD and be used for risk stratification prior to CCTA. The investigators aim to obtain blood samples for biobank purposes and record heart sounds with the CADScor®System in 2000 patients that by clinical evaluation undergo CCTA. In approximately 400 patients (20%), CCTA does not exclude significant CAD. These patients are all examined using Rb PET, 3T CMRI, and ICA with QCA. In patients with a coronary diameter

2018 Clinical Trials

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