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Coronary Risk Stratification of Chest Pain

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

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

2016 Acta Cardiologica Sinica

42. 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

43. 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

44. 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

45. 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

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

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.

2015 Current cardiovascular imaging reports

47. 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

48. 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

49. Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study). (Full text)

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.

2012 American Journal of Cardiology

50. 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

51. 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

52. 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

53. Non-invasive assessment of low- and intermediate-risk patients with chest pain (Full text)

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.

2016 Trends in cardiovascular medicine

54. 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

55. Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis (Full text)

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

2010 DARE.

56. Coronary Computed Tomographic Angiography and Risk of All-Cause Mortality and Non-fatal Myocardial Infarction in Subjects without Chest Pain Syndrome from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Mul (Full text)

Coronary Computed Tomographic Angiography and Risk of All-Cause Mortality and Non-fatal Myocardial Infarction in Subjects without Chest Pain Syndrome from the CONFIRM Registry (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Mul The predictive value of coronary computed tomographic angiography (cCTA) in subjects without chest pain syndrome (CPS) has not been established. We investigated the prognostic value of coronary artery disease detection by cCTA and determined (...) the incremental risk stratification benefit of cCTA findings compared with clinical risk factor scoring and coronary artery calcium scoring (CACS) for individuals without CPS.An open-label, 12-center, 6-country observational registry of 27 125 consecutive patients undergoing cCTA and CACS was queried, and 7590 individuals without CPS or history of coronary artery disease met the inclusion criteria. All-cause mortality and the composite of all-cause mortality and nonfatal myocardial infarction were measured

2012 Circulation

57. CT coronary angiography: new risks for low-risk chest pain. (PubMed)

CT coronary angiography: new risks for low-risk chest pain. Widespread conservative management of low-risk chest pain has motivated the development of a rapid triage strategy based on CT coronary angiography (CTCA) in the Emergency Department (ED). Recently, three prominent trials using this technology in the ED setting have presented results in support of its routine use. However, these studies fail to show the incremental prognostic value of CTCA over clinical and biomarker-based risk (...) -stratification strategies, demonstrate additional downstream costs and interventions, and result in multiple harms associated with radio-contrast and radiation exposure. Observing the widespread overdiagnosis of pulmonary embolism following availability of CT pulmonary angiogram as a practice pattern parallel, CTCA use for low-risk chest pain in the ED should be advanced only with caution.

2012 Emergency Medicine Journal

58. Chest Pain

, Precordial Pain From Related Chapters II. Risk Factors See s See III. Epidemiology Acute and Chest Pain are the two most commonly litigated ED claims IV. Precautions No single finding is absolutely pathognomonic nor completely reassuring in Chest Pain presentation Risk stratification, evaluation and management is based on an overall analysis of all clinical data Approach should be based on combination of factors Exam, ekg and s Consider atypical presentations of coronary syndromes in atypical patients (...) Chest Pain 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 Chest Pain Chest Pain Aka: Chest Pain , Chest Pain Causes

2018 FP Notebook

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

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.

2014 Current cardiovascular imaging reports

60. 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

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