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Coronary Risk Stratification of Chest Pain

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61. Suspected Thoracic Aortic Aneurysm

aortic aneurysm. J Med Assoc Thai. 2010;93(9):1050-1057. 32. Kopp AF, Kuttner A, Trabold T, Heuschmid M, Schroder S, Claussen CD. Multislice CT in cardiac and coronary angiography. Br J Radiol. 2004;77 Spec No 1:S87-97. 33. Schlosser FJ, Mojibian HR, Dardik A, Verhagen HJ, Moll FL, Muhs BE. Simultaneous sizing and preoperative risk stratification for thoracic endovascular aneurysm repair: role of gated computed tomography. J Vasc Surg. 2008;48(3):561-570. 34. Shin HJ, Kim SS, Lee JH, et al (...) Criteria ® “Thoracic Aorta Interventional Planning and Follow-up” [5]. Limitations of CTA include streak artifact from implanted devices, variable quality of images through the aortic root and coronary vessels due to cardiac motion in non-gated studies, and the need for IV iodinated contrast [32-34]. Electrocardiogram (ECG)-gated CTA is often used to minimize cardiac motion artifact and to allow for accurate orthogonal measurement of the ascending thoracic aorta [35,36]. ACR Appropriateness Criteria ®

2017 American College of Radiology

62. GDF-15 predicts cardiovascular events in acute chest pain patients. Full Text available with Trip Pro

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.

2017 PLoS ONE

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

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

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

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

65. 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

66. 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

67. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016 National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016 | The Medical Journal of Australia mja-search search Use the for more specific terms. Title contains Body contains Date range from Date range to Article (...) type Author's surname Volume First page doi: 10.5694/mja__.______ Search Reset  close Individual Login Purchase options Connect person_outline Login keyboard_arrow_down Individual Login Purchase options menu search Advertisement close National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016 Derek P Chew, Ian A Scott, Louise Cullen, John K French, Tom G Briffa, Philip A Tideman

2016 MJA Clinical Guidelines

68. Biomarkers After Risk Stratification in Acute Chest Pain (from the BRIC Study). Full Text available with Trip Pro

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 (...) 2008 to 2009. After clinical risk stratification, N-terminal pro-B-type natriuretic peptide and cystatin C were measured and standard care was performed. The primary end point was the result of a clinical stress test. The secondary end point was any major adverse cardiac event at 6 months. Associations were determined through multivariate stratified analyses. In the low-risk group, 76 of 78 patients with normal levels of the 2 biomarkers had normal stress test results (negative predictive value 97

2012 American Journal of Cardiology

69. 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. (Abstract)

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

70. The association of electrocardiographic abnormalities and major adverse cardiac events in emergency patients with chest pain. Full Text available with Trip Pro

The association of electrocardiographic abnormalities and major adverse cardiac events in emergency patients with chest pain. The electrocardiograph (ECG) is an essential tool in initial management and risk stratification of patients with suspected acute coronary syndrome (ACS). A six-point reporting criterion has been proposed to facilitate standardized clinical assessment of patients presenting to the emergency department (ED) with suspected ACS. We set out to evaluate the efficacy (...) of these criteria in identifying patients with major adverse cardiac events (MACE), Type 1 myocardial infarction (T1MI), Type 2 myocardial infarction (T2MI), and 1-year mortality in a cohort of emergency patients with chest pain.This was an analysis of data from 2,349 patients who presented to the ED with chest pain between 2008 and 2013. Data were collected as part of two prospective trials. ECGs were recorded at presentation and categorized according to the six-point criteria by local cardiologists blinded

2016 Academic Emergency Medicine

71. Documentation of HEART score discordance between emergency physician and cardiologist evaluations of ED patients with chest pain. Full Text available with Trip Pro

classified as high risk by the ED physician, but low risk by the cardiologist.There is substantial discordance in HEART scores between ED physicians and cardiologists. A triage cardiology system may help refine risk stratification of patients presenting to the ED with chest pain, even when the HEART Pathway tool is used.Copyright © 2016 Elsevier Inc. All rights reserved. (...) concurrent ED physician and cardiologist evaluation. Twenty-three patients (70%) had discordant HEART scores (κ = 0.13; 95% confidence interval, -0.02 to 0.32). Discrepancies in the description of patients' chest pain were the most common source of discordance and were present in more than 50% of cases. HEART scores calculated by ED physicians tended to overestimate the scores calculated by cardiologists. When categorized into low-risk or high-risk by the HEART Pathway, more than 25% of patients were

2016 American Journal of Emergency Medicine

72. The HEART score with high-sensitive troponin T at presentation: ruling out patients with chest pain in the emergency room. (Abstract)

The HEART score with high-sensitive troponin T at presentation: ruling out patients with chest pain in the emergency room. The HEART score is a simple scoring system, ranging from 0 to 10, specifically developed for risk stratification of patients with undifferentiated chest pain. It has been validated for the conventional troponin, but not for high-sensitive troponin. We assess a modified version of the HEART score using a single high-sensitivity troponin T dosage at presentation, regardless (...) of symptom duration, and with different ECG criteria to evaluate if the patients with a low HEART score could be safely discharged early. The secondary aim was to confirm a statistically significant difference in each HEART score group (low 0-3, intermediate 4-6, high 7-10) in the occurrence of major adverse cardiac events at 30 and 180 days. We retrospectively analyzed the HEART score of 1597 consecutive patients admitted to the Emergency Department of our Hospital for chest pain between January 1

2016 Internal and emergency medicine

73. The Emerging Roles of Coronary Computed Tomographic Angiography: Acute Chest Pain Evaluation and Screening for Asymptomatic Individuals Full Text available with Trip Pro

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

74. Chest pain: coronary CT in the ER Full Text available with Trip Pro

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

2016 The British journal of radiology

75. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

. In this statement, we provide background on several NMDs in which there is cardiac involvement, highlighting unique features of NMD-associated myocardial disease that require clinicians to tailor their approach to prevention and treatment of heart failure. Undoubtedly, further investigations are required to best inform future guidelines on NMD-specific cardiovascular health risks, treatments, and outcomes. Neuromuscular diseases (NMDs) encompass a broad spectrum of diagnoses with overlapping but distinct (...) Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Management of Cardiac Involvement Associated With Neuromuscular Diseases: 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 March 2019 February 2019 February 2019 February 2019 February 2019 January 2019 January 2019

2017 American Heart Association

76. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

factors can be targeted for preventive intervention. A s survival to adulthood in individuals with congenital heart disease (CHD) has improved, adults with CHD are increasingly at risk for noncardiac com- plications. 1,2 The median age of adults with CHD has increased to 40 years, and the number of adults with CHD >65 years of age is steadily growing. 3–5 As pa- tients age, common adult comorbidities such as diabetes mellitus (DM), coronary artery disease, and hypertension may have an impact on long (...) conditions with congestive heart failure states (im- paired cardiac output and increased central venous pressure) but also likely causes the same neurohor- monal dysregulation that has untoward effects on the kidney. 36,37 Patients with CHD also have unique risk fac- tors for developing renal dysfunction that occur with cardiac surgery and cardiopulmonary bypass. 38–40 Car- diovascular surgery and cardiopulmonary bypass may limit renal blood flow, causing hypoxemic-ischemic injury, and are known

2017 American Heart Association

77. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Gui Full Text available with Trip Pro

Heart failure ACCF/AHA 2017 2016, and 2013 Valvular heart disease AHA/ACC 2017 and 2014 Supraventricular tachycardia ACC/AHA/HRS 2015 Ventricular arrhythmias and the prevention of sudden cardiac death ESC 2015 Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care AHA 2015 Atrial fibrillation AHA/ACC/HRS 2014 Non–ST-elevation acute coronary syndromes AHA/ACC 2014 Assessment of cardiovascular risk ACC/AHA 2013 ST-elevation myocardial infarction ACCF/AHA 2013 Acute myocardial (...) -effectiveness ratio; QALY, quality-adjusted life-years; and WHO-CHOICE, World Health Organization Choosing Interventions that are Cost-Effective. Reproduced from Anderson, et al. 1.2. Organization of the Writing Committee The writing committee consisted of cardiac electrophysiologists (including those specialized in pediatrics), general adult and pediatric cardiologists (including those specialized in critical care and acute coronary syndromes [ACS], genetic cardiology, heart failure, and cost-effectiveness

2017 American Heart Association

78. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

Cardiac Arrest . . . . . . . . . . . . . . e468 19. Subclinical Atherosclerosis . . . . . . . . . . . . e487 20. Coronary Heart Disease, Acute Coronary Syndrome, and Angina Pectoris. . . . . . . . . . e505 21. Cardiomyopathy and Heart Failure . . . . . . . . e523 22. Valvular Diseases . . . . . . . . . . . . . . . . e539 23. Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism), Chronic Venous Insufficiency, Pulmonary Hypertension. . . e548 24. Peripheral Artery Disease and Aortic (...) Cardiac Arrest (Chapter 18) • In the 2015 CARES (Cardiac Arrest Registry to Enhance Survival) National Survival Report for emergency medical services–treated nontrau- matic cardiac arrest, the survival rate to hospital discharge was 10.6% for adults >18 years old, 23.5% for children 13 to 18 years old, 16.6% for children >1 to 12 years old, and 6.2% for children 0. • Coronary artery calcium scores >400 versus 0 are associated with an increased risk for can- cer, chronic kidney disease, pneumonia

2017 American Heart Association

79. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society Full Text available with Trip Pro

dissection, stroke/TIA, cerebral hemorrhage, or significant anemia requiring blood transfusion. AVB indicates atrioventricular block; BBB, bundle-branch block; BP, blood pressure; ECG, electrocardiogram; ED, emergency department; HF, heart failure; MI, myocardial infarction; N/A, not available; NPV, negative predictive value; O 2 Sat, oxygen saturation; OESIL, Osservatorio Epidemiologico sulla Sincope nel Lazio; ROSE, Risk Stratification of Syncope in the ED; SCD, sudden cardiac death; SFSR, San (...) Heart Disease: Recommendations e41 10.3. Geriatric Patients: Recommendations e41 10.4. Driving and Syncope: Recommendation e41 10.5. Athletes: Recommendations e41 11. Quality of Life and Healthcare Cost of Syncope e42 11.1. Impact of Syncope on Quality of Life e42 11.2. Healthcare Costs Associated with Syncope e42 12. Emerging Technology, Evidence Gaps, and Future Directions e42 12.1. Definition, Classification, and Epidemiology e42 12.2. Risk Stratification and Clinical Outcomes e43 12.3

2017 American Heart Association

80. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association Full Text available with Trip Pro

or to determine the presence of pulmonary hypertension. If there is doubt about the presence or absence of pulmonary hypertension, cardiac catheterization should be performed. Estimating Maternal and Fetal Risk Maternal risk in pregnancy is dependent not only on the complexity of the primary cardiac lesion but also on the presence of residual lesions and clinical sequelae such as heart failure, arrhythmias, or cerebrovascular events that contribute to overall risk. Maternal Risk Several risk stratification (...) scores have significant limitations, however, because they are highly population dependent. For example, Canadian Cardiac Disease in Pregnancy included 22% of patients with acquired heart disease, and 4% of the population were included because of arrhythmias. Therefore, in an effort to prevent high-risk patients from becoming pregnant, including those with severe pulmonary hypertension and severely dilated aortas and those who are not represented in these studies, a prepregnancy counseling session

2017 American Heart Association

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