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Coronary Risk Stratification of Chest Pain

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

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

22. 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. (PubMed)

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

23. 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

24. Chest pain in the emergency department: risk stratification with Manchester triage system and HEART score. (PubMed)

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.

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2015 BMC Cardiovascular Disorders

25. Early Risk Stratification in ED Chest Pain Patients

Early Risk Stratification in ED Chest Pain Patients Early Risk Stratification in ED Chest Pain Patients - 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. Early Risk Stratification in ED Chest Pain Patients (...) 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

26. Risk stratification with exercise N13-ammonia PET in adults with anomalous right coronary arteries (PubMed)

Risk stratification with exercise N13-ammonia PET in adults with anomalous right coronary arteries In adults with an interarterial and intramural course of an anomalous right coronary artery from the left sinus (AAORCA), surgical unroofing is recommended in the setting of myocardial ischaemia. However, data regarding functional testing are limited, and the management of adults without ischaemia is unclear. To evaluate these patients, we employed an exercise N(13)-ammonia positron emission (...) tomography (PET) protocol. We hypothesised that patients with typical angina and exertional dyspnoea would be more likely to have ischaemia and that patients without ischaemia could be managed conservatively.Between July 2008 and December 2014, we retrospectively identified 27 consecutive patients >18 years old with an interarterial and intramural course of an AAORCA who had exercise N(13)-ammonia PET.The majority of patients had anatomic delineation with cardiac CT (25, 93%), and most patients had chest

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2016 Open heart

27. Stress-Delta Biomarkers for Acute Coronary Syndrome Risk Stratification

Stress-Delta Biomarkers for Acute Coronary Syndrome Risk Stratification Stress-Delta Biomarkers for Acute Coronary Syndrome 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. Stress-Delta (...) Biomarkers for Acute Coronary Syndrome Risk Stratification 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: NCT02717702 Recruitment Status : Active, not recruiting First Posted : March 24, 2016 Last Update Posted : July 31, 2018 Sponsor: Duke University Information provided by (Responsible Party): Duke

2016 Clinical Trials

28. Coronary Atherosclerosis Disease Early Identification and Risk Stratification by Noninvasive Imaging

Coronary Atherosclerosis Disease Early Identification and Risk Stratification by Noninvasive Imaging Coronary Atherosclerosis Disease Early Identification and Risk Stratification by Noninvasive Imaging - 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 Atherosclerosis Disease Early Identification and Risk Stratification by Noninvasive Imaging (Creation) 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. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03518437

2016 Clinical Trials

29. Chest pain: coronary CT in the ER (PubMed)

Chest pain: coronary CT in the ER Cardiac CT has developed into a robust clinical tool during the past 15 years. Of the fields in which the potential of cardiac CT has raised more interest is chest pain in acute settings. In fact, the possibility to exclude with high reliability obstructive coronary artery disease (CAD) in patients at low-to-intermediate risk is of great interest both from the clinical standpoint and from the management standpoint. Several other modalities, with or without (...) imaging, have been used during the past decades in the settings of new onset chest pain or in acute chest pain for both diagnostic and prognostic assessment of CAD. Each one has advantages and disadvantages. Most imaging modalities also focus on inducible ischaemia to guide referral to invasive coronary angiography. The advent of cardiac CT has introduced a new practice diagnostic paradigm, being the most accurate non-invasive method for identification and exclusion of CAD. Furthermore, the detection

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2016 The British journal of radiology

30. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals (PubMed)

and screening in asymptomatic adults. Several large-scale studies have been conducted to evaluate the diagnostic value of CCTA in the context of acute chest pain patients. CCTA could play a role in delivering more efficient care. For risk stratification of asymptomatic patients using CCTA, latest studies have revealed incremental benefits. Future studies evaluating the totality of plaque characteristics may be useful for determining the role of noncalcified plaque for risk stratification in asymptomatic (...) The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals Coronary computed tomographic angiography (CCTA) has been widely available since 2004. After that, the diagnostic accuracy of CCTA has been extensively validated with invasive coronary angiography for detection of coronary arterial stenosis. In this paper, we reviewed the updated evidence of the role of CCTA in both scenarios including acute chest pain

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2016 Acta Cardiologica Sinica

31. 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 (...) : No Studies a U.S. FDA-regulated Device Product: No Keywords provided by Aleem Khand, Aintree University Hospitals NHS Foundation Trust: acute coronary syndrome; biomarkers, HS troponins Additional relevant MeSH terms: Layout table for MeSH terms Chest Pain Angina, Unstable Pain Neurologic Manifestations Signs and Symptoms Angina Pectoris Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases

2018 Clinical Trials

32. 15 hours of chest pain. Too late for thrombolytics, right? Unstable Angina still exists.

) ischemia. The troponin peaked at a low peak value of 2.0 ng/mL. What if the patient had presented 13 hours previously, after only 2 hours of chest burning? Imagine if she had come to the ED with chest pain of 1 hour duration. Her 0, 2, 4, and 6 hour troponins would have all been negative. Without a positive risk stratification score, she might have been sent home. Of course we do not know what the ECG would have shown, and it very likely would have shown at least subtle signs of LAD ischemia. If her (...) 15 hours of chest pain. Too late for thrombolytics, right? Unstable Angina still exists. Dr. Smith's ECG Blog: 15 hours of chest pain. Too late for thrombolytics, right? Unstable Angina still exists. Friday, September 1, 2017 The time window for therapy with thrombolytics is up to 12 hours after the onset of chest pain, based on many studies done in the thrombolytic era. However, this data comes from studies which took no account of acuteness features on the ECG. ECGs with large upright T

2017 Dr Smith's ECG Blog

33. Non-invasive assessment of low- and intermediate-risk patients with chest pain (PubMed)

Non-invasive assessment of low- and intermediate-risk patients with chest pain Coronary artery disease (CAD) remains a significant global public health burden despite advancements in prevention and therapeutic strategies. Common non-invasive imaging modalities, anatomic and functional, are available for the assessment of patients with stable chest pain. Exercise electrocardiography is a long-standing method for evaluation for CAD and remains the initial test for the majority of patients who can (...) - and intermediate-risk patients with chest pain, where no single study is suitable for all patients. This review will describe currently available non-invasive modalities, along with current evidence-based guidelines and appropriate use criteria in the assessment of low- and intermediate-risk patients with suspected, stable CAD.Copyright © 2017 Elsevier Inc. All rights reserved.

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2016 Trends in cardiovascular medicine

34. Best Clinical Practice: Current Controversies in Evaluation of Low-Risk Chest Pain-Part 1. (PubMed)

risk, nor do they diagnose acute MI. CCTA is an anatomic evaluation of the coronary vasculature with literature support to decrease ED length of stay, though it is associated with downstream testing. Literature is controversial concerning further risk stratification in already low-risk patients.With nonischemic ECG and negative cardiac biomarker, the risk of ACS approaches < 1%. Use of stress test and CCTA for risk stratification of low-risk chest pain patients is controversial. These tests may (...) Best Clinical Practice: Current Controversies in Evaluation of Low-Risk Chest Pain-Part 1. Chest pain is a common presentation to the emergency department (ED), though the majority of patients are not diagnosed with acute coronary syndrome (ACS). Many patients are admitted to the hospital due to fear of ACS.Our aim was to investigate controversies in low-risk chest pain evaluation, including risk of missed ACS, stress test, and coronary computed tomography angiography (CCTA).Chest pain accounts

2016 Journal of Emergency Medicine

35. 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

2015 FP Notebook

36. GDF-15 predicts cardiovascular events in acute chest pain patients. (PubMed)

GDF-15 predicts cardiovascular events in acute chest pain patients. Treatment of patients presenting with possible acute myocardial infarction (AMI) is based on timely diagnosis and proper risk stratification aided by biomarkers. We aimed at evaluating the predictive value of GDF-15 in patients presenting with symptoms suggestive of AMI.Consecutive patients presenting with suspected AMI were enrolled in three study centers. Cardiovascular events were assessed during a follow-up period of 6 (...) presenting with suspected MI. GDF-15 levels correlate with the severity of CAD and can identify and risk-stratify patients who need coronary revascularization.

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2017 PLoS ONE

37. Primary Care Corner with Geoffrey Modest MD: Chest pain prediction tool

these patients as low risk and eligible for early discharge. Commentary: –only 20% of patients coming to the ED with chest pain have acute coronary syndrome. But one of the difficulties is that about 50% with acute coronary syndrome do not have classic symptoms. And 2-6% of patients with acute coronary syndrome are missed by current practice. –Overall in the Netherlands (and other countries), management is conservative and 2/3 of the patients with chest pain get admitted. So, this study adds to the data (...) Primary Care Corner with Geoffrey Modest MD: Chest pain prediction tool Primary Care Corner with Geoffrey Modest MD: Chest pain prediction tool | BMJ EBM Spotlight by by Dr Geoffrey Modest The second article on the ED evaluation of chest pain involved an instrument to predict/stratify cardiac risk, finding it to be quick, reliable and efficient (see doi:10.7326/M16-1600). Details: –Nine Dutch hospitals assessed the HEART instrument prospectively to evaluate unselected patients presenting to EDs

2017 Evidence-Based Medicine blog

38. A 37 year old woman with Chest Pain

this, will educate others about these kinds of subtle findings and prevent future cases like this." Other comment: "It would have been very helpful to record an ECG after the pain was relieved, to see if there is resolution of the hyperacute T-waves. I would not use absence of change to be reassured that this is NOT ischemia, as it is too abnormal to be anything else. But resolution (change) would be confirmatory evidence." Learning Points: 1. We all must learn these high risk findings of coronary occlusion. 2 (...) is abnormal here? Brettford, Yes. I did not mention is because it is opposite to (reciprocal ST elevation) the sagging ST segments in I and II. Steve Anonymous I would think repeat ecgs are absolutely necessary for any patient with chest pain. We tend to undermine the risk of MI in adult women. I would repeat ecg every 15-30 min, until I am satisfied (although I agree that the initial ecg is an LAD lesion staring at my face) if the patient is asymptomatic I would be hesitant to call the cath lab

2016 Dr Smith's ECG Blog

39. Epicardial Fat Volume Improves the Prediction of Obstructive Coronary Artery Disease Above Traditional Risk Factors and Coronary Calcium Score. (PubMed)

reclassification improvement and integrated discrimination improvement, excellent area under the receiver operating characteristic curve and favorable calibration. Further, the new model demonstrated a better prediction of clinical outcome, resulting in a more cost-effective risk stratification to optimize decision-making of downstream diagnosis and treatment.Addition of EFV to conventional risk factors and coronary calcium score offered a more accurate and effective estimation for pretest probability (...) of obstructive coronary artery disease, which may help to improve initial management of stable chest pain.

2019 Circulation. Cardiovascular imaging

40. Is Coronary Computed Tomography Angiography a Resource Sparing Strategy in the Risk Stratification and Evaluation of Acute Chest Pain? Results of a Randomized Controlled Trial. (PubMed)

Is Coronary Computed Tomography Angiography a Resource Sparing Strategy in the Risk Stratification and Evaluation of Acute Chest Pain? Results of a Randomized Controlled Trial. Annually, almost 6 million U.S. citizens are evaluated for acute chest pain syndromes (ACPSs), and billions of dollars in resources are utilized. A large part of the resource utilization results from precautionary hospitalizations that occur because care providers are unable to exclude the presence of coronary artery (...) , perceptions of the value of accessing health care, and clinical outcomes. Resource utilization included services received from both the primary in-network and the primary out-of-network providers. The prospectively defined primary endpoint was the total amount of resources utilized over a 90-day follow-up period when adding CCTA to the SC risk stratification in ACPSs.The mean (± standard deviation [SD]) for total resources utilized at 90 days for in-network plus out-of-network services was less

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2011 Academic Emergency Medicine Controlled trial quality: predicted high

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