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Coronary Risk Stratification of Chest Pain

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41. Computerized Medical History Taking for Acute Chest Pain

, Risk stratification Additional relevant MeSH terms: Layout table for MeSH terms Acute Coronary Syndrome Chest Pain Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Pain Neurologic Manifestations Signs and Symptoms (...) Institutet Information provided by (Responsible Party): Thomas Kahan, Karolinska Institutet Study Details Study Description Go to Brief Summary: The aim is to determine the additional value of computerized, patient-entered medical histories for the management of patients presenting at the emergency department with chest pain. Condition or disease Intervention/treatment Chest Pain Acute Coronary Syndrome Device: CLEOS software program Procedure: Physician taken history Detailed Description: The purpose

2018 Clinical Trials

42. Does an imaging stress-test adds information to prognostic scores in patients with chest pain in the emergency department? (PubMed)

Does an imaging stress-test adds information to prognostic scores in patients with chest pain in the emergency department? We evaluated the ability of a stress-test (Str-T) to improve the risk stratification based on prognostic scores in patients presenting to the ED with chest pain. Between 2008, June and 2013, December, 1082 patients with chest pain were evaluated with an imaging Str-T. With a retrospective analysis, patients were stratified according to: (1) Florence Prediction Rule as low (...) (0-1, LR-FPR), intermediate (2-4, IR-FPR), high risk (5-6, HR-FPR), respectively, 26, 50 and 24% of patients; (2) HEART score as LR-HEART, (0-3) and HR-HEART (≥4), respectively, 36 and 64%; (3) likelihood of CAD according to NICE guidelines, 10-29% LR-NICE, 30-60% IR-NICE and > 60% HR-NICE, respectively, 12, 18 and 70%. Scores' diagnostic performance was calculated with Str-T as reference. One-month follow-up by a phone call was performed, to investigate the occurrence of new cardiovascular

2018 Internal and emergency medicine

43. Impaired renal function is associated with adverse outcomes in patients with chest pain discharged from internal medicine wards. (PubMed)

or <45 ml/min/1.73m2, respectively, p < 0.001).We found an independent graded association between lower eGFR and the risk of death and ACS among patients with chest pain who were discharged from internal medicine wards following an ACS rule-out. The eGFR may be combined in the risk stratification of patients with chest pain.Copyright © 2018. Published by Elsevier B.V. (...) Impaired renal function is associated with adverse outcomes in patients with chest pain discharged from internal medicine wards. Assessment of chest pain is one of the most common reasons for hospital admissions in internal medicine wards. However, little is known regarding predictors for poor prognosis in patients discharged from internal medicine wards after acute coronary syndrome (ACS) rule-out.To assess the association of kidney function with mortality and hospital admissions due to ACS

2018 European journal of internal medicine

44. Prehospital Translation of Chest Pain Tools

Mobile Integrated Healthcare Cumberland County EMS New Hanover Regional Medical Center EMS Information provided by (Responsible Party): Wake Forest University Health Sciences Study Details Study Description Go to Brief Summary: Decision aids such as the HEART Pathway, Emergency Department Assessment of Chest Pain Score (EDACS), Revised Geneva Score and PERC Score have similar ability to accurately risk stratify Emergency Department (ED) patients with possible Acute Coronary Syndrome (ACS (...) risk stratification tools, the HEART Pathway Score, EDACS score, revised Geneva score, and PERC score, among 250 chest pain patients within two large EMS systems. The proposed pilot study has broad-based support from local and state EMS agencies, including Cumberland and New Hanover County EMS agencies. Each tool will be pilot tested and compared in the prehospital setting for feasibility and accuracy. Paramedics will be trained in risk stratification tool use and then will prospectively collect

2018 Clinical Trials

45. Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis

Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis Hess EP, Agarwal D, Chandra S, Murad MH, Erwin PJ, Hollander JE, Montori VM, Stiell IG CRD summary This review concluded that the TIMI risk score (...) is an effective risk stratification tool for patients in the emergency department with potential ACS, but should not be used as the sole means of determining patients disposition. This was generally a well-conducted review, but the available evidence was limited. The authors' conclusion seems appropriate. Authors' objectives To assess the accuracy of the Thrombolysis in Myocardial Infarction (TIMI) score in patients in the emergency department with potential acute coronary syndromes. Searching MEDLINE, EMBASE

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2010 DARE.

46. Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays. (PubMed)

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.

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2013 European Heart Journal

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

variables, suggesting decreased HRV. In bradycardic patients, the same analysis revealed significant differences in predominantly frequency-domain variables suggesting decreased parasympathetic input.Chest pain patients with bradycardia have increased HRV compared to those without bradycardia. This may have important implications on HRV modeling strategies for risk stratification of bradycardic and non-bradycardic chest pain patients.Copyright © 2017 Elsevier Inc. All rights reserved. (...) 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

2017 Journal of Emergency Medicine

48. Pregnancy associated plasma protein-A as a prognostic biomarker of all-cause mortality and cardiovascular events in patients presenting with chest pain: a systematic review. (PubMed)

, irrespectively of the underlying cause. Although the results for long-term events were inconclusive in both groups of patients, higher PAPP-A concentrations were found to be a significant predictor of short-term adverse events in patients with confirmed ischemic chest pain.PAPP-A appears to be a potentially useful biomarker for short-term risk stratification of patients presenting with chest pain of ischemic origin. However, there is an eminent need for more standardized clinical studies investigating (...) Pregnancy associated plasma protein-A as a prognostic biomarker of all-cause mortality and cardiovascular events in patients presenting with chest pain: a systematic review. Novel biomarkers have been proposed for identification of patients at greater risk of future adverse events among those presenting with chest pain. In this review, we aim to elucidate the ability of pregnancy associated plasma protein-A (PAPP-A) to predict mortality and other cardiovascular events in this patient

2017 Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals

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

A retrospective external validation study of the HEART score among patients presenting to the emergency department with chest pain. Emergency physicians must be able to effectively prognosticate outcomes for patients presenting to the Emergency Department (ED) with chest pain. The HEART score offers a prognostication tool, but external validation studies are limited. We conducted an external retrospective validation study of the HEART score among ED patients presenting to our ED with chest pain (...) 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

2017 Internal and emergency medicine

50. The approach to patients with possible cardiac chest pain. (PubMed)

. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term (...) The approach to patients with possible cardiac chest pain. Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone

2017 Medical Journal of Australia

51. Novel Biomarkers: Utility in Patients with Acute Chest Pain and Relationship to Coronary Artery Disease on Coronary CT Angiography (PubMed)

Novel Biomarkers: Utility in Patients with Acute Chest Pain and Relationship to Coronary Artery Disease on Coronary CT Angiography Acute chest pain remains one of the most common patient presentations encountered in the emergency department. With the evolution of biomarkers and improvement in cardiac imaging there has been advancement in risk stratification of patients, but millions of dollars continue to be spent in the assessment of chest pain. Investigators have explored possible comparative (...) alternatives to the traditional work up of chest pain. In this review, we will discuss the current state of biomarker use in the evaluation of acute chest pain. We will review established and emerging circulating biomarkers and their addition to cardiac CT for appropriate diagnosis of coronary artery disease.

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2014 Current cardiovascular imaging reports

52. CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease (PubMed)

CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease To evaluate diagnostic accuracy of exercise ECG (ex-ECG) versus 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in a population with low-to-intermediate pre-test likelihood of coronary artery disease (CAD).Retrospective single centre.Tertiary academic hospital.177 consecutive patients (88 men, 89 women (...) , mean age 53.5±7.6 years) with chest pain and low-to-intermediate pre-test likelihood of CAD were retrospectively enrolled.All patients underwent ex-ECG, CT-CA and invasive coronary angiography (ICA).A lumen diameter reduction of ≥50% was considered as significant stenosis for CT-CA. Ex-ECG was classified as positive, negative or non-diagnostic.were compared with ICA. Diagnostic accuracy of CT-CA and ex-ECG was calculated using ICA as the reference standard. A parallel comparative analysis using

2011 EvidenceUpdates

53. Appropriate Use Criteria: Imaging of the Chest

Arthritis) Pulmonary mass or suspicious parenchymal abnormality on recent chest X-ray or other imaging exam Pulmonary nodule(s) – without a known primary malignancy A nodule is defined as a rounded or regular opacity measuring up to 3 cm in diameter. Nodules are classified as solid or subsolid. Solid nodules are further classified as calcified or non-calcified. Follow-up recommendations are based on classification, as well as patient risk stratification. For calcified nodules, risk may be correlated (...) for cardiac and coronary artery imaging. Please review guidelines for cardiac CT and CCTA. ? Pulmonary embolus is rare in the absence of elevated blood D-dimer levels and certain specific risk factors. Common Diagnostic Indications Indications for chest CTA are contained in general chest, thoracic aorta and great vessel, and pulmonary artery and vein. General Chest Developmental anomalies of the thoracic vasculature ? Examples of congenital thoracic vascular anomalies include but are not limited

2018 AIM Specialty Health

54. Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unit. (PubMed)

Prospective evaluation of the use of the thrombolysis in myocardial infarction score as a risk stratification tool for chest pain patients admitted to an ED observation unit. The Thrombolysis in Myocardial Infarction (TIMI) score has shown use in predicting 30-day and 1-year outcomes in emergency department (ED) patients with potential acute coronary syndrome. Few studies have evaluated the TIMI score in risk stratifying patients selected for the ED observation Unit (EDOU). Risk stratification (...) (5). Risk of composite outcome increased by score: 0 (1%), 1 (2.6%), 2 (2.1%), 3 (6.9%), 4 (11.1%), and 5 (20%). Those with an intermediate risk score (3-5) were also more likely to require admission (15.4% vs 9.8%, P = .048).The TIMI risk score may serve as an effective risk stratification tool among chest pain patients selected for EDOU placement. Patients with intermediate-risk by TIMI may be considered for inpatient admission and/or more aggressive evaluation and therapy.Copyright © 2013

2012 American Journal of Emergency Medicine

55. Improving risk stratification in patients with chest pain: the Erlanger HEARTS(3) score. (PubMed)

Improving risk stratification in patients with chest pain: the Erlanger HEARTS(3) score. The HEART score uses elements from patient History, Electrocardiogram, Age, Risk Factors, and Troponin to obtain a risk score on a 0- to 10-point scale for predicting acute coronary syndromes (ACS). This investigation seeks to improve on the HEART score by proposing the HEARTS(3) score, which uses likelihood ratio analysis to give appropriate weight to the individual elements of the HEART score as well (...) interval difference in areas, 0.064-0.110).The HEARTS(3) score reliably risk stratifies patients with chest pain for 30-day ACS. Prospective studies need to be performed to determine if implementation of this score as a decision support tool can guide treatment and disposition decisions in the management of patients with chest pain.Copyright © 2012 Elsevier Inc. All rights reserved.

2012 American Journal of Emergency Medicine

56. Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study). (PubMed)

Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study). Current models incompletely risk-stratify patients with acute chest pain. In this study, N-terminal pro-B-type natriuretic peptide and cystatin C were incorporated into a contemporary chest pain triage algorithm in a clinically stratified population to improve acute coronary syndrome discrimination. Adult patients with chest pain presenting without myocardial infarction (n = 382) were prospectively enrolled from (...) subgroup that underwent stress testing. In conclusion, N-terminal pro-B-type natriuretic peptide and cystatin C levels predict the results of stress tests in low-risk patients with chest pain but should not be substituted for stress testing in intermediate-risk patients. There is potential for their use in the early discharge of low-risk patients after clinical risk stratification.Copyright © 2013 Elsevier Inc. All rights reserved.

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2012 American Journal of Cardiology

57. Risk Stratification for Coronary Artery Disease With Type 2 Diabetic Patients

Risk Stratification for Coronary Artery Disease With Type 2 Diabetic Patients Risk Stratification for Coronary Artery Disease With Type 2 Diabetic 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 (...) . Risk Stratification for Coronary Artery Disease With Type 2 Diabetic Patients (CAD-risk) 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: NCT02494557 Recruitment Status : Completed First Posted : July 10, 2015 Last Update Posted : May 23, 2017 Sponsor: Acarix Collaborators: Steno Diabetes Center

2015 Clinical Trials

58. Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain

Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest (...) in the emergency department for the evaluation of patients with low-risk chest pain, in comparison with observation unit stay plus either stress electrocardiogram or stress echocardiography. The MDCT risk stratification strategy was less costly and more effective than both observation unit-based strategies. The study was based on valid methodology which, despite limited reporting of some data sources, enhances the validity of the authors’ conclusions. Type of economic evaluation Cost-utility analysis Study

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2008 NHS Economic Evaluation Database.

59. The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries (PubMed)

The Role of Cardiac MRI in Patients with Troponin-Positive Chest Pain and Unobstructed Coronary Arteries Acute coronary syndrome (ACS) still remains one of the leading causes of mortality and morbidity worldwide. Seven to fifteen percent of patients presenting with ACS have unobstructed coronary artery disease (CAD) on urgent angiography. Patients with ACS and unobstructed coronary arteries represent a clinical dilemma and their diagnosis and management is quite variable in current practice (...) on the diagnostic role of cardiac magnetic resonance (CMR) in patients with ACS and unobstructed coronary arteries. We have also highlighted the potential role of CMR as a risk stratification or prognostication tool for this patient population.

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2015 Current cardiovascular imaging reports

60. Inaccuracy of Thrombolysis in Myocardial Infarction and Global Registry in Acute Coronary Events scores in predicting outcome in ED patients with potential ischemic chest pain. (PubMed)

Inaccuracy of Thrombolysis in Myocardial Infarction and Global Registry in Acute Coronary Events scores in predicting outcome in ED patients with potential ischemic chest pain. The Thrombolysis in Myocardial Infarction (TIMI) and the Global Registry in Acute Coronary Events (GRACE) scores were largely evaluated and validated in stratifying risk of cardiovascular events in patients with chest pain and acute coronary syndrome. Our objective was to compare these 2 scores in predicting outcome (...) scores. At 1 year, the area under ROC was 0.67 (95% CI, 0.62-0.71) and 0.65 (95% CI, 0.60-0.70), respectively, for TIMI and GRACE scores.The TIMI and GRACE scores are not valid in short- and long-term risk stratification in our chest pain patients.Copyright © 2015 Elsevier Inc. All rights reserved.

2015 American Journal of Emergency Medicine

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