How to Trip Rapid Review

Step 1: Select articles relevant to your search (remember the system is only optimised for single intervention studies)

Step 2: press

Step 3: review the result, and maybe amend the or if you know better! If we're unsure of the overall sentiment of the trial we will display the conclusion under the article title. We then require you to tell us what the correct sentiment is.

1,349 results for

Coronary Risk Stratification of Chest Pain

by
...
Alerts

Export results

Use check boxes to select individual results below

SmartSearch available

Trip's SmartSearch engine has discovered connected searches & results. Click to show

21. Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

. The ESC criteria for intermediate-risk PE are broader and include patients who have a simplified Pulmonary Embolism Severity Index (PESI) score ≥1 (ie, age >80 years; cancer, chronic respiratory disease, or cardiac disease; heart rate >110 bpm; systolic blood pressure <100 mm Hg; or oxygen saturation <90%), regardless of whether there is RV strain. The ESC then subdivides intermediate-risk patients into 2 subgroups according to whether patients have both RV dysfunction and RV injury (intermediate risk (...) assessments of the patient. Some have already been studied in a limited fashion. , , , Table 3. Future Directions of Research for Risk Stratification Assessment Modality Current AHA/ESC Focus Future Directions Clinical assessment Systolic blood pressure Syncope Cardiac arrest Diastolic blood pressure Mean blood pressure Heart rate Oxygen saturation and partial pressure Respiratory rate Objective functional capacity Patient-reported distress Acute cognitive impairment Biomarker assessment Troponin Brain

2019 American Heart Association

22. Stressed out about stress testing? The utility of stress testing after non-ACS chest pain Full Text available with Trip Pro

Intern Med . March 2015:428. doi: 7. Natsui S, Sun BC, Shen E, et al. Evaluation of Outpatient Cardiac Stress Testing After Emergency Department Encounters for Suspected Acute Coronary Syndrome. Annals of Emergency Medicine . August 2019:216-223. doi: 8. Park S, Sanchez D. The limited utility of cardiac stress testing in low-intermediate risk young adults presenting with chest pain. Circulation . 2016;134:A16436. . 9. Morgernstern J. Stress tests part 3: stress test accuracy. First10 EM Blog (...) Stressed out about stress testing? The utility of stress testing after non-ACS chest pain Stressed out about stress testing? The utility of stress testing after non-ACS chest pain - CanadiEM Stressed out about stress testing? The utility of stress testing after non-ACS chest pain In by Vivian Tam October 15, 2019 The Case Your next patient in the acute zone of the ED is Mr. Liu, a 53-year old man presenting with one hour of acute onset atypical chest pain. He has several risk factors

2019 CandiEM

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

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 (...) , they do not have adequate sensitivity or are not easy to use in the ED. The Vancouver chest pain and North American chest pain rules may be used for patients with undifferentiated chest pain in the ED. The Manchester Acute Coronary Syndromes rule uses eight factors, several of which are not available in the United States. The history, electrocardiography, age, risk factors, and troponin (HEART) score and pathway are easy to use, have high sensitivity and negative predictive values, and have better

2016 Journal of Emergency Medicine

24. Novel Risk Stratification Assays for Acute Coronary Syndrome Full Text available with Trip Pro

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

2017 Current cardiology reports

25. 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 Full Text available with Trip Pro

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

2014 Netherlands Heart Journal

26. Impact of the HEART Pathway on Admission Rates for Emergency Department Patients with Chest Pain: An External Clinical Validation Study. (Abstract)

pathway).We conducted an impact analysis of the HEART pathway. Patients with a HEART score ≥ 4 underwent hospital admission for cardiac risk stratification and monitoring. Patients with a HEART score ≤ 3 could opt for discharge with 72-h follow-up in lieu of admission. We collected data on cohorts prior to and after implementation of the new disposition pathway. For each cohort, we screened the charts of 625 consecutive chest pain patients. We measured patient demographics, past medical history, vital (...) Impact of the HEART Pathway on Admission Rates for Emergency Department Patients with Chest Pain: An External Clinical Validation Study. Chest pain is a common emergency department (ED) chief complaint. Safe discharge mechanisms for low-risk chest pain patients would be useful.To compare admission rates prior to and after implementation of an accelerated disposition pathway for ED patients with low-risk chest pain based upon the HEART (History, ECG, Age, Risk factors, Troponin) score (HEART

2018 Journal of Emergency Medicine

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

" 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 (...) 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

2016 Journal of cardiovascular computed tomography

28. Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial. (Abstract)

Serial sampling of copeptin levels improves diagnosis and risk stratification in patients presenting with chest pain: results from the CHOPIN trial. Copeptin has demonstrated a role in early rule out for acute myocardial infarction (AMI) in combination with a negative troponin. However, management of patients with chest pain with a positive copeptin in the setting of a negative troponin is unclear.The multicentre CHOPIN trial enrolled 2071 patients with acute chest pain. Of these, 476 subjects (...) of 14 pmol/L. When the second copeptin was elevated there were 18 AMIs (4.9%) compared with 0 (0%) when the second copeptin was negative (p=0.017), yielding a negative predictive value of 100% (95% CI 96.7% to 100%). On 30-day follow-up there were 36 MACEs (9.9%) in the positive second copeptin group and 2 (1.8%) MACEs in the negative second copeptin group (p=0.006).Patients with chest pain with an initial negative troponin but positive copeptin are common and carry an intermediate risk of AMI

2016 Emergency Medicine Journal

29. Implementation of a Risk Stratification and Management Pathway for Acute Chest Pain in the Emergency Department Full Text available with Trip Pro

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

2016 Critical Pathways in Cardiology

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

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

31. Early Risk Stratification in ED Chest Pain Patients

design and participants This prospective observational study was conducted in the Prince of Wales Hospital in Hong Kong. Chest pain adult patients suspected with acute coronary syndrome were recruited. Point-of-care H-FABP and hs-cTnT tests, TIMI score and CT scan for coronary calcium score were performed on study subjects. Patients were followed-up at 30-day and 6 months for the occurrence of major adverse cardiac events. In 2014, a modified HEART score incorporating hs-cTnT was included as one (...) Observational Model: Cohort Time Perspective: Prospective Official Title: Improving Early Risk Stratification in Patients Presenting to Emergency Departments With Undifferentiated Chest Pain Study Start Date : March 2013 Actual Primary Completion Date : October 2014 Actual Study Completion Date : October 2014 Resource links provided by the National Library of Medicine related topics: Groups and Cohorts Go to Group/Cohort Intervention/treatment MACE groups Patients with major adverse cardiac events occurred

2015 Clinical Trials

32. 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. (Abstract)

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

33. Biomarkers and Risk Scores for Risk Stratification of Unstable Angina

that very low levels of detected troponin in patients with stable coronary artery disease do adversely impact on cardiac death and the development of heart failure. Condition or disease Chest Pain Study Design Go to Layout table for study information Study Type : Observational Actual Enrollment : 489 participants Observational Model: Cohort Time Perspective: Prospective Official Title: Can a Multi-marker Strategy Improve Risk Stratification and Expedite Discharge in Unstable Angina? A Comparison (...) brain natriuretic peptide), ischaemia (Heart-type fatty acid protein) and a novel marker of stress, raised in a number of pathological states growth differentiation factor -15, add significantly to the prognostic value of clinical information and resting ECG presenting with ischaemic sounding chest pain. The 5th generation troponin assay will be used and the range of values from 1-14ng/l will also be compared to the biomarkers studied in terms of hard cardiac endpoints. Recent studies have indicated

2018 Clinical Trials

34. Canadian Cardiovascular Society Guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery

, cardiopulmonary testing) will Table 1. Computation of Revised Cardiac Risk Index score Variable Points History of ischemic heart disease* 1 History of congestive heart failure y 1 History of cerebrovascular disease z 1 Use of insulin therapy for diabetes 1 Preoperative serum creatinine> 177 mmol/L (> 2.0 mg/dL) 1 High-risk surgery x 1 ECG, electrocardiogram. *De?ned as a history of myocardial infarction, positive exercise test, current complaint of ischemic chest pain or nitrate use, or ECG with path (...) - ological Q waves; patients with previous coronary bypass surgery or angio- plasty meet criteria if they have such ?ndings after their procedure. y De?ned as a history of heart failure, pulmonary edema, or paroxysmal nocturnaldyspnea;anS3galloporbilateralralesonphysicalexamination;ora chest radiograph showing pulmonary vascular resistance. z De?ned as a stroke or transient ischemic attack. x De?ned as intraperitoneal, intrathoracic, or suprainguinal vascular surgery. Table 2. Total RCRI score

2017 CPG Infobase

35. A retrospective external validation study of the HEART score among patients presenting to the emergency department with chest pain. (Abstract)

from 1 January 2014 to 9 June 2014. We utilized chart review methodology to abstract data from each patient's electronic medical record. We collected data relevant to each of the five elements of the HEART score: history, electrocardiogram (ECG) interpretation, patient age, patient risk factors, and troponin levels. We calculated the diagnostic accuracy of the HEART score (0-10) for predicting the primary outcome of major adverse cardiac events (MACE) over 6 weeks following the ED visit (coronary (...) operator curve (AUROC) is 0.885 (95% confidence interval 0.838-0.931). Patients with a HEART score ≤3 are at low risk for 6-week MACE. Hence, these patients may be candidates for outpatient follow-up instead of inpatient admission for cardiac risk stratification.

2017 Internal and emergency medicine

36. Heart Rate Variability Analysis in Patients Who Have Bradycardia Presenting to the Emergency Department with Chest Pain. (Abstract)

Heart Rate Variability Analysis in Patients Who Have Bradycardia Presenting to the Emergency Department with Chest Pain. Heart rate variability (HRV) is a noninvasive method to measure the function of the autonomic nervous system. It has been used to risk stratify patients with undifferentiated chest pain in the emergency department (ED). However, bradycardia can have a modifying effect on HRV.In this study, we aimed to determine how bradycardia affected HRV analysis in patients who presented (...) with chest pain to the ED.Adult patients presenting to the ED at Singapore General Hospital with chest pain were included in the study. Patients with non-sinus rhythm on electrocardiogram (ECG) were excluded. HRV parameters, including time domain, frequency domain, and nonlinear variables, were analyzed from a 5-min ECG segment. Occurrence of a major adverse cardiac event ([MACE], e.g., acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or mortality) within 30

2017 Journal of Emergency Medicine

37. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

sequenced the protein-coding regions of >10 000 individuals within the PROMIS study (Pakistan Risk of Myocardial Infarction), made up of subpopulations with a high prevalence of consanguinity, and identified homozygous loss-of-function mutations and related phenotypes in many genes, including APOC3 (a gene harboring known mutations protective for coronary heart disease), thereby articulating a systemic survey of “human knockouts” through studying this unique population. Future Directions to Better (...) Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association | Circulation Search Hello Guest! Login to your account Email Password Keep me logged in Search March 2019 March 2019 March 2019 March 2019

2018 American Heart Association

38. Cardiac arrhythmias in coronary heart disease

recommendations that should be prioritised for implementation. 2.1 ARRHYTHMIAS ASSOCIATED WITH CARDIAC ARREST R Efforts to prevent sudden cardiac death should include: y risk factor intervention in those individuals who are at high risk for coronary heart disease y health promotion measures and encouragement of moderate-intensity physical activity in the general population. 2.2 ARRHYTHMIAS ASSOCIATED WITH ACUTE CORONARY SYNDROME R All patients with ST-elevation acute coronary syndrome should undergo (...) assessment of LV function for risk stratification at least six weeks following the acute event. 2.3 ARRHYTHMIAS ASSOCIATED WITH CHRONIC CORONARY HEART DISEASE/LEFT VENTRICULAR DYSFUNCTION R Rate control is the recommended strategy for management of patients with well-tolerated atrial fibrillation. R In patients with permanent AF or persistent AF following a rate-control strategy and a resting heart rate >110 bpm, appropriate rate-control therapy should be instituted with an initial target of resting

2018 SIGN

39. CADScor system for ruling out coronary artery disease in people with symptoms of stable coronary artery disease

examination, 12-lead ECG) but before CT coronary angiography (CTCA). The main points from the e main points from the evidence vidence summarised in this briefing are from 2 prospective observational studies involving a total of 1,900 adults referred to coronary computed tomography or invasive coronary angiography because of symptoms suggestive of stable coronary artery disease. Based on the reported diagnostic accuracy of CAD-score for coronary artery disease, they show the CADScor system can allow risk (...) stratification that is superior to clinical risk scores. K Ke ey uncertainties y uncertainties around the evidence are that it is limited in quantity, with no data from an NHS setting. Evidence supporting its diagnostic accuracy is in people of European family origin only. © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 of 10The cost cost of CADScor system is £4,460 per unit (exclusive of VAT). The technology may

2019 National Institute for Health and Clinical Excellence - Advice

40. Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. Full Text available with Trip Pro

Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. Several high-sensitivity cardiac troponin (hs-cTn) assays have recently been developed. It is unknown which hs-cTn provides the most accurate prognostic information and to what extent early changes in hs-cTn predict mortality.In a prospective, international multicentre study, cTn was simultaneously measured with three novel [high-sensitivity cardiac Troponin T (hs-cTnT), Roche Diagnostics (...) the incremental value of changes. Hs-cTn concentrations remained predictors of death in clinically challenging subgroups such as patients with pre-existing coronary artery disease, impaired renal function, and patients older than 75 years.High-sensitivity cardiac Troponin T is more accurate than hs-cTnI in the prediction of long-term mortality. Changes of hs-cTn do not seem to further improve risk stratification beyond initial presentation values.

2013 European Heart Journal

To help you find the content you need quickly, you can filter your results via the categories on the right-hand side >>>>