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Coronary Risk Stratification of Chest Pain

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61. Low Risk Chest Pain Under Age 40

of the provider EKG shows no ST elevations or depressions Vital signs are stable (no hypotension) No history of known heart disease Cardiac blood tests (troponin or CK-MB), if performed, are negative (normal) Source Document: Christenson et al. A clinical prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006;47(1):1–10. Cullen et al. Comparison of Three Risk Stratification Rules for Predicting Patients With Acute Coronary Syndrome Presenting to an Australian Emergency Department (...) Low Risk Chest Pain Under Age 40 Low Risk Chest Pain Under Age 40 in the Emergency Department – TheNNTTheNNT Risk Assessment: Low Risk Chest Pain Under Age 40 in the Emergency Department 1 in 1000 for heart attack If the patient meets the below criteria for this assessment: 99.9% did not have a heart attack or a death 0.1% did have a heart attack or a death In Other Words: The risk of a heart attack was 1 in 1000 Risk Assessment Criteria Low risk chest pain according to the judgment

2010 theNNT

62. Low Risk Chest Pain Over Age 40

prediction rule for early discharge of patients with chest pain. Ann Emerg Med. 2006;47(1):1–10. Cullen et al. The new Vancouver Chest Pain Rule using troponin as the only biomarker: an external validation study. Amer J Emerg Med. 2014;32(129-134) Cullen et al. Comparison of Three Risk Stratification Rules for Predicting Patients With Acute Coronary Syndrome Presenting to an Australian Emergency Department. Heart, Lung, and Circulation 2013;22:844-851. Goldstein et al. The CT-STAT (Coronary Computed (...) reviewed In Other Words: After Only An Initial Biomarker: 1 in 80 will have a heart attack After A 2nd Set of Biomarkers (at 6 hours): 1 in 250 will have a heart attack Risk Assessment Criteria Low risk chest pain according to the judgment of the provider EKG shows no ST elevations or depressions Vital signs are stable (no hypotension) Cardiac blood tests (troponin or CK-MB), if performed, are negative (normal) No history of known coronary artery disease Source Document: Christenson et al. A clinical

2010 theNNT

63. 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 (PubMed)

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

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2012 Circulation

64. Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. (PubMed)

Admission glycaemia and its association with acute coronary syndrome in Emergency Department patients with chest pain. This study aims to evaluate admission blood glucose level (BGL) in patients presenting to the emergency department (ED) as a risk factor for a major adverse cardiac event (MACE) on presentation and up to 30 days post discharge. Admission BGL is a prognostic indicator in patients with confirmed acute coronary syndrome (ACS). It is unclear if admission BGL improves the diagnosis (...) and stratification of patients presenting to the ED with suspected ACS.This study is an analysis of data collected from a prospective observational study. The study population consisted of ED patients from Brisbane, Australia and Christchurch, New Zealand. Patients were enrolled between November 2007 and February 2011. Admission BGL was taken as part of routine admission blood with fasting status unknown. The primary end point for this study was a MACE at presentation and up to 30 days post discharge. Logistic

2014 Emergency Medicine Journal

65. Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome (PubMed)

be of benefit to detect chest pain resulting in MI from that of non-cardiac one, and also for risk stratification of patients who suffered from an acute chest discomfort.Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved. (...) Diagnostic importance of admission platelet volume indices in patients with acute chest pain suggesting acute coronary syndrome Acute coronary syndrome (ACS) is a challenging issue in cardiovascular medicine. Given platelet role in atherothrombosis, we sought to determine whether platelet indices can be used as diagnostic tests for patients who suffered from an acute chest discomfort.We prospectively enrolled 862 patients with an acute chest pain and 184 healthy matched controls. They were

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2014 Indian heart journal

66. Retrospective Study of Acute Chest Pain in Extremely Critical Condition for More Than Ten Years

status was: Recruiting First Posted : July 19, 2016 Last Update Posted : July 25, 2016 Sponsor: Qilu Hospital of Shandong University Information provided by (Responsible Party): Qilu Hospital of Shandong University Study Details Study Description Go to Brief Summary: Acute non-traumatic chest pain is a common kind of symptom in extremely critical condition, with various pathogenesis and different level of risk . Chest pain in high risk takes 1/3 of that. It mainly includes acute coronary syndrome (...) , nausea etc), physical signs and lab examination in early diagnosis and risk stratification of acute chest pain in extremely critical condition. To study the effect factors of thrombus burden in STEMI patients, at the same time, creat a a simple, practical and scientific method of blood clots classification. Condition or disease Acute Myocardial Infarction Pulmonary Embolism Aortic Dissection Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 7000

2016 Clinical Trials

67. The association of electrocardiographic abnormalities and major adverse cardiac events in emergency patients with chest pain. (PubMed)

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 (...) criteria, were associated with increasing rates of MACE. Within 30 days, T1MI occurred in 148 (6.3%) patients and T2MI occurred in 59 (2.5%) patients. Risk for T1MI increased with higher classification of ECG abnormalities. T2MI rates were highest in patients with ECGs of nonspecific changes.The rates of MACE, T1MI, and 1-year death can be stratified according to standardized ECG criteria in patients presenting to the ED with chest pain. The ECG findings in patients with T2MI are variable, and the ECG

2016 Academic Emergency Medicine

68. 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

69. 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

70. Does Coronary Artery Calcium Scoring Add to the Predictive Value of Coronary Computed Tomography Angiography for Adverse Cardiovascular Events in Low-risk Chest Pain Patients? (PubMed)

Does Coronary Artery Calcium Scoring Add to the Predictive Value of Coronary Computed Tomography Angiography for Adverse Cardiovascular Events in Low-risk Chest Pain Patients? Coronary angiography calcium score (CACS) is included for patients who receive coronary computed tomography angiography (CTA) as part of diagnostic testing for low-risk chest pain. Both tests add radiation exposure, and it is unclear whether the combination provides more information than either test alone. The objective (...) was to asses if CACS = 0 determines freedom from coronary artery disease (CAD) and whether the addition of CACS to coronary CT angiography provides additional risk stratification information or helps predict 30-day cardiovascular outcomes.This was a secondary analysis of a prospective cohort study at an urban university hospital emergency department (ED), of patients with symptoms suggestive of potential acute coronary syndrome (ACS) and low Thrombolysis in Myocardial Infarction (TIMI) risk scores who

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2011 Academic Emergency Medicine

71. Prospective validation of Thrombolysis in Myocardial Infarction and front door Thrombolysis in Myocardial Infarction risk scores in Chinese patients presenting to the ED with chest pain. (PubMed)

for TIMI0 to 37.5% for patients with TIMI6/7. Increasing TIMI and FDTIMI scores were associated with a higher incidence of MACE.This validation suggests that the TIMI/FDTIMI scores can be employed in Hong Kong Chinese; they may be useful for risk stratification of Chinese ED patients with undifferentiated chest pain elsewhere.Copyright © 2014 Elsevier Inc. All rights reserved. (...) Prospective validation of Thrombolysis in Myocardial Infarction and front door Thrombolysis in Myocardial Infarction risk scores in Chinese patients presenting to the ED with chest pain. Chest pain is a common complaint among emergency department (ED) patients. The Thrombolysis in Myocardial Infarction (TIMI) and front door TIMI (FDTIMI) scores are used to risk stratify chest pain patients in many Western countries; they have not been validated in patients with undifferentiated chest pain

2014 American Journal of Emergency Medicine

72. Sepsis as an important risk factor for gastrointestinal bleeding in acute coronary syndrome patients: Two case reports. (PubMed)

by authoritative guidelines for acute coronary syndrome (ACS), does not include sepsis as a bleeding risk factor.The 2 cases were about ACS with hemorrhagic complications. The first patient was an 88-year-old man with hypertension, gallstones, hepatic cysts, and chest pain; the second one was a 79-year-old man with chest pain and hypertension. These 2 ACS patients had no bleeding on admission; however, both patients suffered apparent gastrointestinal bleeding immediately after the development of sepsis (...) Sepsis as an important risk factor for gastrointestinal bleeding in acute coronary syndrome patients: Two case reports. Sepsis is a common stressor that may decrease microcirculation in the gastrointestinal tract in patients and increase the gastrointestinal bleeding risk of stress-related mucosal disease. However, the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines) bleeding risk score, recommended

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2018 Medicine

73. Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain. (PubMed)

Chronic kidney disease as a risk factor for acute coronary syndromes in patients presenting to the emergency room with chest pain. We sought to determine whether persons with intermediate risk factors for cardiovascular disease presenting to an emergency department with chest pain and chronic kidney disease (CKD) were triaged effectively by chest pain units (CPUs). CPUs evaluate patients with intermediate risk and acute chest pain effectively. CKD is a risk factor for poor outcomes once (...) that CKD is a strong predictor of hospitalization and overall long-term mortality in patients presenting with chest pain to the emergency department. Current risk factor stratification scoring systems should consider CKD as a predictor of increased risk in patients with chest pain.Copyright © 2012. Published by Mosby, Inc.

2012 Translational research : the journal of laboratory and clinical medicine

74. Guidelines on Chronic Coronary Syndromes

Prospective Multicenter Imaging Study for Evaluation of Chest Pain PTP Pre-test probability RAS Renin−angiotensin system RCT Randomized clinical trial REACH Reduction of Atherothrombosis for Continued Health RIVER-PCI Ranolazine for Incomplete Vessel Revascularization Post‐Percutaneous Coronary Intervention SCORE Systematic COronary Risk Evaluation SCOT- HEART Scottish Computed Tomography of the HEART SIGNIFY Study Assessing the Morbidity–Mortality Benefits of the If Inhibitor Ivabradine in Patients (...) revascularization 38 5.2 Patients >1 year after initial diagnosis or revascularization 38 6. Angina without obstructive disease in the epicardial coronary arteries 40 6.1 Microvascular angina 41 6.1.1 Risk stratification 41 6.1.2 Diagnosis 41 6.1.3 Treatment 41 6.2 Vasospastic angina 42 6.2.1 Diagnosis 42 6.2.2 Treatment 42 7. Screening for coronary artery disease in asymptomatic subjects 43 8. Chronic coronary syndromes in specific circumstances 44 8.1 Cardiovascular comorbidities 44 8.1.1 Hypertension 44

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2019 European Society of Cardiology

75. Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry. (PubMed)

Machine learning of clinical variables and coronary artery calcium scoring for the prediction of obstructive coronary artery disease on coronary computed tomography angiography: analysis from the CONFIRM registry. Symptom-based pretest probability scores that estimate the likelihood of obstructive coronary artery disease (CAD) in stable chest pain have moderate accuracy. We sought to develop a machine learning (ML) model, utilizing clinical factors and the coronary artery calcium score (CACS (...) for all comparisons. CACS, age, and gender were the highest ranking features.A ML model incorporating clinical features in addition to CACS can accurately estimate the pretest likelihood of obstructive CAD on CCTA. In clinical practice, the utilization of such an approach could improve risk stratification and help guide downstream management.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.

2019 European Heart Journal

76. Cardiac arrhythmias in coronary heart disease

assessment of LV function for risk stratification at least six weeks following the acute event. 2.3 ARRHYTHMIAS ASSOCIATED WITH CHRONIC CORONARY HEART DISEASE/LEFT VENTRICULAR DYSFUNCTION R Rate control is the recommended strategy for management of patients with well-tolerated atrial fibrillation. R In patients with permanent AF or persistent AF following a rate-control strategy and a resting heart rate >110 bpm, appropriate rate-control therapy should be instituted with an initial target of resting (...) artery bypass graft surgery 29 6.1 Introduction 29 6.2 Risk factors 29 6.3 Prophylactic interventions 29 6.4 Treatments for atrial fibrillation 32 6.5 Treatments for ventricular arrhythmias 34 6.6 Preoperative information 35 7 Psychosocial issues 36 7.1 Introduction 36 7.2 Psychosocial assessment and screening 36 7.3 Psychosocial issues for ICD recipients 37 7.4 Psychosocial interventions 37 7.5 Antidepressant medications in patients with coronary heart disease 38 8 Provision of information 39 8.1

2018 SIGN

77. Gut microbiota-dependent trimethylamine N-oxide in acute coronary syndromes: a prognostic marker for incident cardiovascular events beyond traditional risk factors. (PubMed)

, the prognostic value of TMAO in the setting of acute coronary syndromes (ACS) remains unknown.We investigated the relationship of TMAO levels with incident cardiovascular risks among sequential patients presenting with ACS in two independent cohorts. In the Cleveland Cohort, comprised of sequential subjects (n = 530) presenting to the Emergency Department (ED) with chest pain of suspected cardiac origin, an elevated plasma TMAO level at presentation was independently associated with risk of major adverse (...) patients presenting with chest pain predict both near- and long-term risks of incident cardiovascular events, and may thus provide clinical utility in risk stratification among subjects presenting with suspected ACS.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

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2017 European Heart Journal

78. Asymptomatic Patient at Risk for Coronary Artery Disease

Assoc Radiol J. 2009;60(1):19-34. 27. Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed (...) Clinical Condition: Asymptomatic Patient at Risk for Coronary Artery Disease Variant 1: Low risk. Radiologic Procedure Rating Comments RRL* CT coronary calcium 3 In patients with strong family history, this study may be of value. ??? Fluoroscopy heart 2 ?? US echocardiography transthoracic resting 2 O X-ray chest 1 ? CTA coronary arteries with IV contrast 1 ??? MRI heart with stress without and with IV contrast 1 O MRI heart with stress without IV contrast 1 O MRI heart function and morphology without

2013 American College of Radiology

79. Modified TIMI risk score cannot be used to identify low-risk chest pain in the emergency department: a multicentre validation study. (PubMed)

Modified TIMI risk score cannot be used to identify low-risk chest pain in the emergency department: a multicentre validation study. The Thrombolysis in Myocardial Infarction (TIMI) risk score (range 0-7), used for emergency department (ED) risk stratification of patients with suspected acute coronary syndrome (ACS), underestimates risk associated with ECG changes or cardiac troponin elevation. A modified TIMI score (mTIMI, range 0-10), which gives increased weighting to these variables, has (...) ) for standard TIMI, respectively.mTIMI score performs better than standard TIMI score for ED risk stratification of chest pain, but neither is sufficiently sensitive at scores >0 to allow safe and early discharge without further investigation or follow-up. Observed differences in performance may be due to incorporation bias.

2013 Emergency Medicine Journal

80. Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test. (PubMed)

Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test. This study investigated the diagnostic yield of invasive coronary angiography (CAG) and the impact of noninvasive test (NIV) in patients presented to emergency department (ED) with acute chest pain.Patients 50 years or older who visited ED with acute chest pain and underwent CAG were identified retrospectively. Those with ischemic electrocardiogram, elevated cardiac enzyme, known coronary (...) = .026] for detection of CAD; 45.0% vs 50.5% [P = .285] for revascularization). Positive results of NIV were significantly associated with the presence of CAD and the need for revascularization, when compared with patients without NIV or patients with negative results (P < .001, respectively).The diagnostic yield of CAG was only 65% in low- to intermediate-risk ED patients with acute chest pain. Performing of NIV provided only modest improvement in diagnostic yield of CAG. The unexpectedly low

2013 American Journal of Emergency Medicine

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