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Coronary Risk Stratification of Chest Pain

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81. 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

82. 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

83. Arrhythmias in Congenital Heart Disease: A Position Paper of EHRA, AEPC, and ESC Working Group on Grown-up Congenital Heart Disease

of CHD predispose to arrhythmias even without any surgical intervention due to abnormalities of the conduction system, intrinsic structural pathology, and impact of pre- or post- operative cyanosis and volume-/pressure-overload. In general, surgery for congenital heart defects may result in sinus node dys- function, atrioventricular (AV) block and a variety of supraventric- ular and ventricular tachyarrhythmias including the risk of sudden cardiac death (SCD). Arrhythmia treatment in patients (...) Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy; 14 Center for Electrophysiology at Heart Center Bremen, Bremen, Germany; 15 2nd Faculty of Medicine, Children’s Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic; 16 Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany; 17 SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad

2017 Heart Rhythm Society

84. Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease Full Text available with Trip Pro

Figure 1 AUC Development Process 2217 3. Assumptions 2218 General Assumptions 2218 Assumptions for Rating Multiple Treatment Options 2219 4. Definitions 2219 Table A. Revascularization to Improve Survival Compared With Medical Therapy 2220 Table B. Noninvasive Risk Stratification 2222 5. Abbreviations 2223 6. Coronary Revascularization in Patients With Stable Ischemic Heart Disease: Appropriate Use Criteria (By Indication) 2223 Section 1. SIHD Without Prior CABG 2223 Table 1.1 One-Vessel Disease 2224 (...) /ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons

2017 Society for Cardiovascular Angiography and Interventions

85. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Hea Full Text available with Trip Pro

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 analyses), a geriatrician with expertise in terminal care and shared decision-making, and a lay representative, in addition to representatives from the ACC, AHA (...) 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 infarction in patients presenting with ST-segment elevation ESC 2012 Device-based therapies for cardiac rhythm abnormalities ACCF/AHA/HRS 2012 Coronary

2017 American Heart Association

86. Diagnosis and Management of Acute Pulmonary Embolism Full Text available with Trip Pro

Integration of aggravating conditions and comorbidity into risk assessment of acute pulmonary embolism 20 5.6 Prognostic assessment strategy 20 6 Treatment in the acute phase 22 6.1 Haemodynamic and respiratory support 22 6.1.1 Oxygen therapy and ventilation 22 6.1.2 Pharmacological treatment of acute right ventricular failure 22 6.1.3 Mechanical circulatory support and oxygenation 23 6.1.4 Advanced life support in cardiac arrest 23 6.2 Initial anticoagulation 23 6.2.1 Parenteral anticoagulation 23 6.2.2 (...) normalized ratio IU International units i.v Intravenous IVC Inferior vena cava LA Left atrium LMWH Low-molecular weight heparin(s) LV Left ventricle/ventricular MRA Magnetic resonance angiography NCT National clinical trial NOAC(s) Non-vitamin K antagonist oral anticoagulant(s) NT-proBNP N-terminal pro B-type natriuretic peptide NYHA New York Heart Association OBRI Outpatient Bleeding Risk Index o.d Omni die (once a day) OR Odds ratio PAH Pulmonary arterial hypertension PAP Pulmonary artery pressure PE

2019 European Society of Cardiology

87. Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: results from the CHOPIN trial. Full Text available with Trip Pro

Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: results from the CHOPIN trial. Chest pain is a common complaint to emergency departments (EDs) and clinical risk factors are used to predict which patients are at risk for worse outcomes and mortality. The goal was to assess the novel biomarker midregional proadrenomedullin (MR-proADM) in prediction of mortality and major adverse cardiac events (MACE).This was a subanalysis (...) and had similar results in those with noncardiac diagnoses. MR-proADM concentrations were stratified by decile, and the cohort in the top decile had a 9.8% 6-month mortality risk versus 0.9% risk for those in the bottom nine deciles (p < 0.0001). MR-proADM, history of coronary artery disease (CAD), and hypertension were predictors of short-term MACE, while history of CAD, hypertension, cTnI, and MR-proADM were predictors of long-term MACE.In patients with chest pain, MR-proADM predicts mortality

2015 Academic Emergency Medicine

88. 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. (Abstract)

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

89. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

on the management of #COPD exacerbations from @ERStalk and @atscommunity Executive summary Chronic obstructive pulmonary disease (COPD) exacerbations are episodes of increased respiratory symptoms, particularly dyspnoea, cough and sputum. The European Respiratory Society (ERS) and American Thoracic Society (ATS) collaborated to develop guidelines that address questions regarding the treatment of COPD exacerbations that are not clearly answered by current guidelines. Key recommendations from the guidelines (...) Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline | European Respiratory Society Main menu User menu Search Search for this keyword Search for this keyword Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline Jadwiga A. Wedzicha (ERS co-chair) , Marc Miravitlles , John R. Hurst , Peter M.A

2017 European Respiratory Society

90. 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 (...) is a pathway just published for hs troponin T. Note that is still uses ECG and risk stratification!! Posted by Steve Smith at Labels: , , , , Reactions: 9 comments: Great point Stephen. I wouldn't have hesitated to send someone with that ECG to cath, regardless of time from onset. We have shown that high-sensitivity troponin does not elevate even in echo-proven myocardial ischemia on a stress test: Myocardial Ischemia on Cardiac Stress Testing Is Not Associated with Changes in Troponin T Levels

2017 Dr Smith's ECG Blog

91. Best Clinical Practice: Current Controversies in Evaluation of Low-Risk Chest Pain-Part 1. (Abstract)

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

92. Non-invasive assessment of low- and intermediate-risk patients with chest pain Full Text available with Trip Pro

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 (...) exercise adequately with a baseline interpretable electrocardiogram. The addition of cardiac imaging to exercise testing provides incremental benefit for accurate diagnosis for CAD and is particularly useful in patients who are unable to exercise adequately and/or have uninterpretable electrocardiograms. Radionuclide myocardial perfusion imaging and echocardiography with exercise or pharmacological stress provide high sensitivity and specificity in the detection and further risk stratification

2016 Trends in cardiovascular medicine

93. Diagnostic accuracy of the TIMI risk score in patients with chest pain in the emergency department: a meta-analysis Full Text available with Trip Pro

, Cochrane Database of Systematic Reviews, Web of Science and Scopus were searched without language restrictions from January 2000 to February 2009. Conference proceedings for three relevant societies from 2007 to 2009 and reference lists of eligible articles were searched. Experts were contacted. Study selection Prospective studies that validated the TIMI risk score in patients with chest pain to predict the short-term risk of cardiac events in the emergency department were eligible for inclusion (...) of more than zero and more than 1. Meta-regression showed a strong linear relationship between TIMI risk score and cumulative incidence of cardiac events (p<0.001). Authors' conclusions Although TIMI risk score is an effective risk stratification tool for patients in the emergency department with potential acute coronary syndromes, it should not be used as the sole means of determining patients disposition. CRD commentary The review addressed a clear research question supported by appropriate

2010 DARE.

94. CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis Full Text available with Trip Pro

. Scott C.G. Kyle R.A. et al. Natural history of wild-type transthyretin cardiac amyloidosis and risk stratification using a novel staging system. J Am Coll Cardiol. 2016; 68 : 1014-1020 after diagnosis. Different therapeutic modalities have been investigated in recent years using transthyretin stabilizers (eg, diflunisal and tafamidis), suppressors of ATTR synthesis (gene silencers), and amyloid fibrils degraders (doxycycline with tauroursodeoxycholic acid or ursodeoxycholic acid and epigallocatechin (...) of suggestive clinical indices, health care providers should consider the possibility of cardiac amyloidosis and proceed with proper investigation. Tafamidis is the first agent shown in a prospective study to alter outcomes in patients with transthyretin cardiac amyloidosis. Patient subgroups with HFpEF might benefit from use of sacubitril/valsartan, however, further data are needed to clarify the effect of this therapy in patients with HFpEF. Sodium glucose cotransport inhibitors reduce the risk

2020 Canadian Cardiovascular Society

95. 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 available with Trip Pro

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

96. Sepsis as an important risk factor for gastrointestinal bleeding in acute coronary syndrome patients: Two case reports. Full Text available with Trip Pro

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

2018 Medicine

97. 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. (Abstract)

, 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

98. CT coronary angiography: new risks for low-risk chest pain. (Abstract)

-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. (...) 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

2012 Emergency Medicine Journal

99. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

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 (...) test 18 3.1.5.6 Invasive testing 19 3.1.6 Step 6: assess event risk 21 3.1.6.1 Definition of levels of risk 22 3.2 Lifestyle management 23 3.2.1 General management of patients with coronary artery disease 23 3.2.2 Lifestyle modification and control of risk factors 23 3.2.2.1 Smoking 23 3.2.2.2 Diet and alcohol 24 3.2.2.3 Weight management 24 3.2.2.4 Physical activity 24 3.2.2.5 Cardiac rehabilitation 24 3.2.2.6 Psychosocial factors 24 3.2.2.7 Environmental factors 25 3.2.2.8 Sexual activity 25

2019 European Society of Cardiology

100. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

al, 1996 38 Yes No Change in LVEF better Some patients received thymomodulin Ongoing trials Prednisone+AZA NCT01877746 234 Yes No Change in LVEF at 12 mo Virus negative required IVIG NCT00892112 50 Yes Yes Change in LVEF at 6 mo Evidence for parvovirus Anakinra NCT03018834 120 No Yes Days alive free of HF complications Diagnosis by chest pain, Tn, CMR AZA indicates azathioprine; CMR, cardiac magnetic resonance; CyA, cyclosporine A; HF, heart failure; HLA, human leukocyte antigen; IA, intra (...) and transfer of such patients to centers that have the capacity and experience to manage patients with FM is essential. Presenting Signs and Symptoms Clinical presentations vary widely, with or without systemic manifestations of an infection or inflammatory disorder. In the European Study of Epidemiology and Treatment of Inflammatory Heart Disease of 3055 patients, most of those screened had dyspnea followed by chest pain and arrhythmias such as atrial fibrillation, ventricular tachycardia, or heart block

2020 American Heart Association

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