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Coronary Risk Stratification of Chest Pain

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761. Risk Stratification of Non ST Elevation ACS With Computed Tomographic Angiography (REACT)

have enabled CTA to clearly define coronary artery anatomy with great accuracy and to guide treatment strategies in select patient populations. We are investigating that CTA may be used, as an alternative to conventional angiograms, for the risk stratification of patients with high risk NSTE-ACS. Patients eligible for the study will be high risk NSTE-ACS and awaiting an angiogram. Enrolled patients will undergo CTA prior to the angiogram. With each CTA the patient will be injected with a small dose (...) Additional relevant MeSH terms: Layout table for MeSH terms Infarction Myocardial Infarction Acute Coronary Syndrome Angina, Unstable Non-ST Elevated Myocardial Infarction Ischemia Pathologic Processes Necrosis Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Angina Pectoris Chest Pain Pain Neurologic Manifestations Signs and Symptoms

2007 Clinical Trials

762. Initial risk stratification and presenting characteristics of patients with evolving myocardial infarctions. (PubMed)

Initial risk stratification and presenting characteristics of patients with evolving myocardial infarctions. To describe the presenting characteristics and risk stratification of patients presenting to the emergency department with chest pain who have a normal initial troponin level followed by a raised troponin level within 12 h (evolving myocardial infarction (EMI)).Data from the Internet Tracking Registry for Acute Coronary Syndromes (i*trACS), a registry of patients presenting (...) with NSTEMI than those with no MI with respect to demographic characteristics, presentation, admission patterns and revascularisation. The initial ECG in patients with EMI was most commonly non-diagnostic (51%), but physicians' initial impressions commonly reflected MI, unstable angina or high-risk chest pain (76%). This risk assessment was followed by a high rate of critical care admissions (32%) and revascularisation (percutaneous coronary intervention 17%) among patients with EMI.Patients with EMI

2008 Emergency Medicine Journal

763. Prognostic value of myeloperoxidase in patients with chest pain. (PubMed)

Prognostic value of myeloperoxidase in patients with chest pain. Inflammation is linked to adverse outcomes in acute coronary syndromes. Myeloperoxidase, an abundant leukocyte enzyme, is elevated in culprit lesions that have fissured or ruptured in patients with sudden death from cardiac causes. Numerous lines of evidence suggest mechanistic links between myeloperoxidase and both inflammation and cardiovascular disease.We assessed the value of plasma levels of myeloperoxidase as a predictor (...) myeloperoxidase independently predicts the early risk of myocardial infarction, as well as the risk of major adverse cardiac events in the ensuing 30-day and 6-month periods. Myeloperoxidase levels, in contrast to troponin T, creatine kinase MB isoform, and C-reactive protein levels, identified patients at risk for cardiac events in the absence of myocardial necrosis, highlighting its potential usefulness for risk stratification among patients who present with chest pain.Copyright 2003 Massachusetts Medical

2003 NEJM

764. Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification. (PubMed)

Guidelines for the management of patients with chronic stable angina: diagnosis and risk stratification. Patients with suspected chronic stable angina can be evaluated in three stages. In stage one, the clinician uses information from the history, physical examination, laboratory tests for diabetes and hyperlipidemia, and resting electrocardiography to estimate the patient's probability of coronary artery disease (CAD). In stage two, additional testing for patients with a low probability of CAD (...) focuses on diagnosing noncoronary causes of chest pain. Patients with a high probability of CAD have stress tests to assess their risk from CAD, and patients with an intermediate probability of CAD have stress tests to estimate the probability of CAD and assess their risk from CAD. Most patients with new-onset angina can start stress testing with exercise electrocardiography. The initial stress test should be a stress imaging procedure for patients with rest ST-segment depression greater than 1 mm

2001 Annals of Internal Medicine

765. Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. PRISM Study Investigators. Platelet Receptor Inhibition in Ischemic Syndrome Management. (PubMed)

with tirofiban.We enrolled 2222 patients of the Platelet Receptor Inhibition in Ischemic Syndrome Management study with coronary artery disease and who had had chest pain in the previous 24 h. All patients received aspirin and were randomly assigned treatment with tirofiban or heparin. We took baseline measurements of troponin I and troponin T. We recorded death, myocardial infarction, or recurrent ischaemia after 48 h infusion treatment and at 7 days and 30 days.629 (28.3%) patients had troponin I (...) Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. PRISM Study Investigators. Platelet Receptor Inhibition in Ischemic Syndrome Management. A major challenge for physicians is to identify patients with acute coronary syndromes who may benefit from treatment with glycoprotein-IIb/IIIa-receptor antagonists. We investigated whether troponin concentrations can be used to stratify patients for benefit from treatment

1999 Lancet Controlled trial quality: uncertain

766. Weekend and Holiday Exercise Testing in Patients with Chest Pain (Full text)

of hospitalization saved and incremental costs incurred in conjunction with weekend or holiday testing.Urban tertiary care academic medical center.A total of 195 patients were scheduled for testing, and 181 tests were performed. Over three quarters (75.1%) of patients underwent testing for assessment of chest pain. Other indications included risk stratification after myocardial infarction or coronary angioplasty or prior to noncardiac surgery, or evaluation for arrhythmias, dyspnea, or syncope.Outcomes included (...) days of hospitalization ($316.83 per patient tested). Event rates over the 6 months following discharge were low.Weekend and holiday exercise testing is a safe and effective means of risk stratification prior to hospital discharge for patients with chest pain. It also reduces length of stay and is cost saving.

1999 Journal of General Internal Medicine

767. A rapid troponin-I-based protocol for assessing acute chest pain. (PubMed)

A rapid troponin-I-based protocol for assessing acute chest pain. In a prospective randomized open trial with 30-day follow-up, we compared a troponin-I-based protocol to 'standard management' for the diagnosis and risk stratification of patients with acute non-ST-elevation chest pain. Patients with acute chest pain (n=400) were randomized to standard diagnostic tests and management, or a protocol based on the admission ECG and the troponin-I result 6 h after onset of chest pain. Low-risk (...) compared to standard management (3% vs. 5%, p=0.32). It identified a group of patients at moderate risk of cardiac events (15% MACE rate during admission and 30-day follow-up), and a high-risk group (75% MACE rate) more accurately than did standard management. The prognostic power of troponin testing in combination with the admission ECG was higher than with either test used alone. The protocol improved the efficiency of low-risk patient management, and improved patient risk stratification. This study

2001 QJM : monthly journal of the Association of Physicians Controlled trial quality: uncertain

768. Application of the TIMI risk score in ED patients with cocaine-associated chest pain. (PubMed)

Application of the TIMI risk score in ED patients with cocaine-associated chest pain. The TIMI risk score has been validated as a risk stratification tool in emergency department (ED) patients with potential acute coronary syndrome. The goal of this study was to assess its ability to predict adverse cardiovascular outcomes in cocaine-associated chest pain.This was a prospective cohort study of ED patients with chest pain with cocaine use. Data included demographics, medical history, and TIMI (...) % (0.1-100).The TIMI risk score has no clinically useful predictive value in patients with cocaine-associated chest pain.

2007 American Journal of Emergency Medicine

769. Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population. (PubMed)

Prospective validation of the Thrombolysis in Myocardial Infarction Risk Score in the emergency department chest pain population. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a 7-item tool derived from trials of patients with unstable angina/non-ST segment elevation myocardial infarction for risk stratification with respect to outcomes. It has been retrospectively evaluated in emergency department (ED) patients with potential acute coronary syndrome but has not been (...) prospectively validated in this patient population. To validate the use of the TIMI risk score in the ED, we prospectively assess its potential utility in a broad ED chest pain patient population.This was a prospective observational cohort study of consecutive ED chest pain patients enrolled from July 2003 until October 2004. Data included demographics, medical and cardiac history, and components of the TIMI risk score. Investigators followed the hospital course daily for admitted patients, and 30-day

2006 Annals of Emergency Medicine

770. Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department. (Full text)

Low-risk patients with chest pain and without evidence of myocardial infarction may be safely discharged from emergency department. This study is an audit of the risk stratification of patients admitted to a university hospital emergency department with a suspected acute coronary syndrome (ACS). The main aim of the study was to investigate the prognosis of those patients who were discharged to home from the emergency room (ER) or adjacent chest pain observation unit (CPU).Three thousand one (...) weeks after the discharge from the ER and CPU cardiovascular mortality was 0.1% and 0.5% and during 6 months 0.8% and 1.7%, respectively. Within 6 months 4.2% and 8.4% of the patients were hospitalized for ACS and 9.3% and 11.5% had a cardiovascular disease event.Patients admitted with chest pain may be safely discharged from the emergency department, if there is no evidence of MI or high-risk ACS. However, further examination and appropriate treatment must be arranged.

2004 European Heart Journal

771. Computed Tomographic Coronary Angiography for Acute Chest Pain Evaluation

Computed Tomographic Coronary Angiography for Acute Chest Pain Evaluation Computed Tomographic Coronary Angiography for Acute Chest Pain Evaluation - 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. Computed (...) Tomographic Coronary Angiography for Acute Chest Pain Evaluation (EDCCTA) 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: NCT00615719 Recruitment Status : Terminated (Enrollment rate was too slow.) First Posted : February 14, 2008 Results First Posted : December 8, 2011 Last Update Posted : December 8, 2011

2007 Clinical Trials

772. The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. (Full text)

The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries. Troponin measurement is used in the assessment and risk stratification of patients presenting acutely with chest pain when the main cause of elevation is coronary artery disease. However, some patients have no coronary obstruction on angiography, leading to diagnostic uncertainty. We evaluated the incremental diagnostic value of cardiovascular magnetic (...) resonance (CMR) in these patients.Sixty consecutive patients (mean age 44 years, 72% male) with a troponin-positive episode of chest pain and unobstructed coronary arteries were recruited within 3 months of initial presentation. All patients underwent CMR with cine imaging, T2-weighted imaging for detection of inflammation, and late gadolinium enhancement imaging for detection of infarction/fibrosis. An identifiable basis for troponin elevation was established in 65% of patients. The commonest

2007 European Heart Journal

773. New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: a comparison with the TIMI risk score. (Full text)

that of the TIMI risk score for the primary (C index of 0.78 vs. 0.66, p = 0.0002) and secondary (C index of 0.70 vs. 0.66, p = 0.1) end points.Patients presenting with chest pain despite no ST-segment deviation or troponin elevation show a non-negligible rate of events at one year. A risk score derived from this specific population allows more accurate stratification than when using the TIMI risk score. (...) New risk score for patients with acute chest pain, non-ST-segment deviation, and normal troponin concentrations: a comparison with the TIMI risk score. The purpose of this research was to develop a risk score for patients with chest pain, non-ST-segment deviation electrocardiogram (ECG), and normal troponin levels.Prognosis assessment in this population remains a challenge.A total of 646 consecutive patients were evaluated by clinical history (risk factors and chest pain score according to pain

2005 Journal of the American College of Cardiology

774. Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. (Full text)

Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome. Evaluation of patients who present to the hospital with a complaint of chest pain or other signs or symptoms suggestive of acute coronary syndrome (ACS) is time-consuming, expensive, and problematic. Recent investigations have indicated that increases in biomarkers upstream from biomarkers of necrosis (cardiac troponins I and T), such as inflammatory cytokines, cellular adhesion molecules, acute (...) -phase reactants, plaque destabilization and rupture biomarkers, biomarkers of ischemia, and biomarkers of myocardial stretch may provide earlier assessment of overall patient risk and aid in identifying patients with higher risk of an adverse event.The purpose of this review is to provide an overview of the pathophysiology and clinical and analytical characteristics of several biomarkers that may have potential clinical utility to identify ACS patients. These biomarkers (myeloperoxidase

2005 Clinical Chemistry

775. Usefulness of stress echocardiography for risk stratification of patients after percutaneous coronary intervention. (PubMed)

Usefulness of stress echocardiography for risk stratification of patients after percutaneous coronary intervention. The prognostic value of stress echocardiography in patients with previous percutaneous coronary intervention (PCI) remains undefined. The aim of this study was to investigate the prognostic implication of stress echocardiography after PCI. The study group comprised 1,063 patients (794 men, 65 +/- 10 years of age) who underwent stress echocardiography with exercise (n = 105 (...) ), dipyridamole (n = 780), or dobutamine (n = 178) after a median of 10 months from a successful PCI. Of these patients, 616 (58%) complained of chest pain and 447 (42%) were asymptomatic. Stress echocardiogram was positive for inducible ischemia in 328 patients (31%). During a median follow-up of 20 months, there were 167 events (61 deaths, 106 infarctions). Independent predictors of mortality were age (hazard ratio [HR] 1.06, 95% confidence interval [CI] 1.03 to 1.09, p <0.0001), wall motion score index

2008 American Journal of Cardiology

776. Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome. (Full text)

Efficacy of myocardial contrast echocardiography in the diagnosis and risk stratification of acute coronary syndrome. We examined the hypothesis that myocardial contrast echocardiography (MCE) is superior to conventional electrocardiographic, echocardiographic, and troponin I criteria for the diagnosis of acute coronary syndrome. We prospectively enrolled 114 consecutive patients (60+/-10 years of age, 73 men) who presented to the emergency room with chest pain on exertion and at rest (...) . Exclusion criteria included an age<40 years, presence of Q wave or ST-segment elevation, and a poor echocardiographic window. Echocardiography and MCE were performed to assess regional wall motion abnormalities (RWMAs) and myocardial perfusion defects by using continuous infusion of perfluorocarbon-exposed sonicated dextrose albumin. Acute coronary syndrome was confirmed in 87 patients. There were no deaths; 46 patients had acute myocardial infarction, and 41 patients required urgent revascularization

2005 American Journal of Cardiology

777. Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. (PubMed)

of microvascular dysfunction (P<0.0001). EFT of >0.45 cm had 85% sensitivity and 75% specificity to detect CFR <2 (P<0.0001). Traditional risk factors for atherosclerosis did not predict women with abnormal microvascular function.EFT has the potential to be an additional and easy diagnostic tool for risk stratification of women with chest pain and angiographically normal coronary arteries. (...) Relation between epicardial fat thickness and coronary flow reserve in women with chest pain and angiographically normal coronary arteries. A significant proportion of women with angina-like chest pain and angiographically normal coronary arteries have microvascular dysfunction as detected by reduced coronary blood flow reserve (CFR). Classical clinical risk factors of atherosclerosis poorly predict this scenario. We sought to assess whether increased epicardial fat tissue, which

2008 Atherosclerosis

778. Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography. (Full text)

Unanswered questions for management of acute coronary syndrome: risk stratification of patients with minimal disease or normal findings on coronary angiography. The prognostic implication of chest pain associated with normal or near-normal findings on angiography is still unknown. We explored outcomes and methods of risk stratification in patients with nonobstructive coronary artery disease in the setting of non-ST-segment elevation acute coronary syndromes.Data were pooled from 3 Thrombolysis (...) in Myocardial Infarction (TIMI) trials (TIMI 11B, TIMI 16, and TIMI 22). Angiographic data were available on 7656 patients with non-ST-segment elevation acute coronary syndromes. The primary end point of this analysis was the composite of the rates of death, myocardial infarction, unstable angina requiring rehospitalization, revascularization, and stroke at 1-year follow-up. Outcomes were evaluated by mean of the TIMI risk score for developing at least 1 component of the primary end point.Angiographic

2006 Archives of Internal Medicine

779. Derivation and validation of a risk stratification model to identify coronary artery disease in women who present to the emergency department with potential acute coronary syndromes. (PubMed)

Derivation and validation of a risk stratification model to identify coronary artery disease in women who present to the emergency department with potential acute coronary syndromes. To derive and validate a model to identify women who would benefit from further evaluation of chest pain after an initial negative emergency department (ED) evaluation for acute coronary syndrome (ACS).The derivation and validation cohorts were comprised of women who presented to the ED with chest pain at two (...) were four of 1,348 (0.30%), 18 of 498 (3.6%), and 71 of 594 (11.9%) in the low-, moderate-, and high-risk groups, respectively.The risk of underlying CAD in women who present to the ED with potential ACS may be determined using a simple risk stratification score.

2004 Academic Emergency Medicine

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

patients presenting to the ED.A decision analytic model was developed to compare health outcomes and costs that result from three different risk stratification strategies for low-risk chest pain patients in the ED: stress ECG testing after OU care, stress echocardiography after OU care, and MDCT with no OU care. Three patient populations were modeled with the prevalence of symptomatic coronary artery disease (CAD) being very low risk, 2%; low risk, 6% (base case); and moderate risk, 10%. Outcomes were (...) Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain. The aim was to use a computer model to estimate the cost-effectiveness of 64-slice multidetector computed tomography (MDCT) of the coronary arteries in the emergency department (ED) compared to an observation unit (OU) stay plus stress electrocardiogram (ECG) or stress echocardiography for the evaluation of low-risk chest pain

2008 Academic Emergency Medicine

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