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Coronary Risk Stratification of Chest Pain

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81. Usefulness of computed tomographic coronary angiography in patients with acute chest pain with and without high-risk features (PubMed)

Usefulness of computed tomographic coronary angiography in patients with acute chest pain with and without high-risk features The accuracy of 64-slice computed tomographic coronary angiography (CTA) and its ability to direct revascularization in patients with acute chest pain syndrome (ACPS) was investigated. A total of 107 patients with ACPS presenting to the emergency department and referred to cardiology were prospectively enrolled and underwent CTA. From the clinical features, the patients (...) were categorized as having high-risk acute coronary syndrome features or no high-risk features. At the treating physician's discretion, the patients underwent risk stratification with either invasive coronary angiography (ICA) or technetium-99m single photon emission computed tomography. All tests were interpreted by experts unaware of the clinical information. All 52 patients with high-risk acute coronary syndrome features underwent ICA. Of the 55 patients with no high-risk features, 36 underwent

2010 EvidenceUpdates

82. Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography

Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography - 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. Evaluation of Subclinical COronary Atherosclerosis for Risk Stratification Using Coronary Computed Tomography (CT) Angiography (ESCORT) 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: NCT01416532 Recruitment

2011 Clinical Trials

83. Exploratory examination of the need for revision of the DMP "coronary heart disease"

between the need for oxygen and the oxygen supply in the heart muscle and subsequently to myocardial ischaemia. This commonly manifests itself as angina pectoris (AP), that is, sudden pain in the chest, jaw, arm or other regions, lasting seconds to minutes [9]. The development of heart failure, myocardial infarction, or sudden cardiac death may be consequences of CHD [10]. CHD is a chronic disease. Stable AP is a clinical form of manifestation of CHD that reproducibly occurs under physical or mental (...) stress and is constant over months. In contrast, acute phases of CHD that are directly life-threatening or fatal are summarized under the term “acute coronary syndrome”. This also includes unstable AP occurring under slight or no physical activity, myocardial infarction with or without ST-segment elevations, as well as sudden cardiac death [11,12]. Risk factors for the development of CHD include increasing age, male sex, smoking, obesity, hypertension, hypercholesterolaemia, and diabetes mellitus

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

84. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain. (PubMed)

Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain. Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain.suPAR concentrations were measured on admission in 449 consecutive chest pain patients (...) improved the predictive accuracy of abnormal ECG findings and increased troponin concentrations regarding all-cause mortality (c statistics, 0.751-0.805; P < 0.0001).suPAR is a strong predictor of adverse long-term outcomes and improves risk stratification beyond traditional risk variables in chest pain patients admitted with suspected NSTEACS.

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2013 Clinical Chemistry

85. 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

86. Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions

imbalance, or ongoing pain, bleeding, ischemia, or dysrhythmia after the procedure. In addition, some patients may be considered higher risk for complications based on coronary anatomy, left ventricular dysfunction, procedural complexity, and comorbidities. Finally, there may be appropriate logistical reasons that require a patient to remain in the hospital overnight, such as procedures that end too late in the day for a safe discharge the same day, lack of transportation, or inadequate social support (...) □ Medications have been delivered from Pharmacy □ Work/School Excuse Print and Review the After Visit Summary 8.2 PCI for acute coronary syndrome including primary PCI for STEMI Although some patients with ACS were included in the observational studies of SDD, many patients are hospitalized for longer than one day to confirm the diagnosis of NSTEACS, undergo invasive risk stratification, and ensure adequate recovery. If PCI is performed, discharge can proceed once a patient meets the milestones outlined

2018 Society for Cardiovascular Angiography and Interventions

87. Stable Coronary Artery Disease (2nd Edition)

Score (CAC) 49 6.3.2 Diagnostic Accuracy of Computed Tomography Angiography (CTA) 50 6.3.3 Diagnostic Accuracy of Invasive Coronary Angiography (ICA) 51 7. RISK STRATIFICATION IN STABLE CAD 53 7.1 Risk Stratification of Stable CAD by Clinical Evaluation 54 7.2 Risk Stratification of Stable CAD by Resting ECG 55 7.3 Risk Stratification of Stable CAD by Left Ventricular Function 55 7.4 Risk Stratification of Stable CAD by Non-invasive Testing 55 7.5 Risk Stratification of Stable CAD by Anatomic (...) testing 56 7.5.1 Coronary Calcium (CAC) Score 56 7.5.2 Computed Tomography Angiography (CTA) 57 7.5.3 Risk Stratification by Invasive Coronary Angiography (ICA) 58 7.5.4 Risk assessment by Physiological Assessment of the functional severity of coronary lesions 58 7.6 Guidelines for referral to a tertiary cardiac center 60 8. MANAGEMENT (Fig 2, pg 25) 62 8.1 Behavioural modification therapy (BMT) 63 8.1.1 Patient education 63 8.1.2 Diet 63 8.1.3 Physical activity 63 8.1.4 Smoking Cessation 67 8.1.5

2018 Ministry of Health, Malaysia

88. Sirens to Scrubs: Acute Coronary Syndrome – Beyond Door-to-Balloon

Sirens to Scrubs: Acute Coronary Syndrome – Beyond Door-to-Balloon Sirens to Scrubs: Acute Coronary Syndromes, Part One - Beyond Door-to-Balloon - CanadiEM Sirens to Scrubs: Acute Coronary Syndromes, Part One – Beyond Door-to-Balloon In , by Richard Armour September 27, 2018 Emergency Medical Services receives a 9-1-1 call for a 52-year-old female suffering with chest pain. As Paramedics rush to the scene, they discuss the physiology of Acute Coronary Syndromes… About Sirens to Scrubs Sirens (...) as a 10/10 and is neither positional nor reproducible on palpation. As her partner acquires a 12-lead ECG, the attending paramedic considers which risk factors and historical findings may indicate an acute coronary syndrome… Incident History & Risk Stratification It is worth prefacing this section by reiterating the need to maintain a high index of suspicion for ACS in women, the elderly, diabetic patients, and patients with a number of significant co-morbidities. 4,5,11 In these patient groups

2018 CandiEM

89. A 37 year old woman with Chest Pain

this, will educate others about these kinds of subtle findings and prevent future cases like this." Other comment: "It would have been very helpful to record an ECG after the pain was relieved, to see if there is resolution of the hyperacute T-waves. I would not use absence of change to be reassured that this is NOT ischemia, as it is too abnormal to be anything else. But resolution (change) would be confirmatory evidence." Learning Points: 1. We all must learn these high risk findings of coronary occlusion. 2 (...) is abnormal here? Brettford, Yes. I did not mention is because it is opposite to (reciprocal ST elevation) the sagging ST segments in I and II. Steve Anonymous I would think repeat ecgs are absolutely necessary for any patient with chest pain. We tend to undermine the risk of MI in adult women. I would repeat ecg every 15-30 min, until I am satisfied (although I agree that the initial ecg is an LAD lesion staring at my face) if the patient is asymptomatic I would be hesitant to call the cath lab

2016 Dr Smith's ECG Blog

90. Coronary computed tomography angiography in patients with chronic chest pain: systematic review of evidence base and cost-effectiveness. (PubMed)

Coronary computed tomography angiography in patients with chronic chest pain: systematic review of evidence base and cost-effectiveness. The diagnostic evaluation of patients without known coronary artery disease presenting with chronic stable chest pain or angina equivalent is complex. Imaging often plays a role in diagnosis and risk stratification, and a variety of techniques are available, each with inherent and situation-specific advantages and disadvantages. Coronary computed tomography (...) angiography (CTA) has been proposed as a fast, noninvasive, reliable test to rule out disease in this population, with potential improvements in costs and outcomes compared with alternative strategies. The relatively rapid rise in coronary CTA utilization, however, has led to strong calls from clinicians and health care policy organizations alike to provide high-level evidence supporting its use. The present article provides a review of the available evidence. Alternative diagnostic strategies

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2012 Journal of thoracic imaging

91. 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

92. 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

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2016 Academic Emergency Medicine

93. CIMT and Plaque Assessment Findings in Subjects Undergoing Stress Echocardiography For Risk Stratification

, CABG, angina) No peripheral vascular disease No history of stroke or TIA Statins, antihypertensives, ASA treatment OK Exclusion Criteria: History of CAD, CABG, PTCA, coronary or peripheral stenting History of stroke/TIA/peripheral vascular disease Inability to exercise on the treadmill Unwilling/unable to sign informed consent History of neck radiation or neck surgery or inability to obtain neck images End stage renal disease Preoperative evaluation History of chest pain Contacts and Locations Go (...) CIMT and Plaque Assessment Findings in Subjects Undergoing Stress Echocardiography For Risk Stratification CIMT and Plaque Assessment Findings in Subjects Undergoing Stress Echocardiography For Risk Stratification - 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

2014 Clinical Trials

94. Risk stratification of patients suspected of coronary artery disease: Comparison of five different models. (PubMed)

Risk stratification of patients suspected of coronary artery disease: Comparison of five different models. To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris.Retrospective cohort for creation of CORSCORE by means of logistic regression analysis. Prospective (...) cohort for validation of the five risk models using receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Significant CAD was defined as lumen area diameter reduction ≥50% at coronary angiography. All risk models include information on age, sex, and symptoms. In addition the Duke, Morise, and CORSCORE models include information on tobacco use and hypercholesterolemia. Duke and Morise also include information

2011 Atherosclerosis

95. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

frequently coexists with mental stress, characterized by a hypercoagulable state, chronic pain patients may be at an increased risk of coronary or cerebrovascular events after discontinuation of protective antiplatelet and anticoagulant medications. This underscores the importance of coordinating the perioperative handling of these medications with the prescribing cardiologist or neurologist. | Nonsteroidal Anti-inflammatory Drugs Nonsteroidal anti-inflammatory drugs inhibit prostaglandin production (...) , ASA may be discontinued for a longer period, 6 days, to ensure complete platelet functional recovery.112 In individuals utilizing ASA for secondary prophylaxis undergoing high-risk procedures, a shared assessment, risk stratification and management decision should involve the interventional pain physician, patient, and physician prescribing ASA. The risk of bleeding while continuing ASA needs to be weighed against the cardiovascular risks of stopping ASA. Documentation of decision making should

2018 American Society of Regional Anesthesia and Pain Medicine

96. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

instability, respiratory compromise, immunosuppression) in critically ill adults; implementation of assessment-driven and standardized pain management protocols improves ICU outcomes and clinical practice ( , ). Carefully titrated analgesic dosing is important when balancing the benefits versus potential risks of opioid exposure ( ). In this guideline section, we address three actionable questions and two descriptive questions related to the pain experience of critically ill adults (see prioritized topic (...) list in Supplemental Table 1 [Supplemental Digital 2, ] and voting results in Supplemental Table 2 [Supplemental Digital Content 3, ]). The evidence summaries and evidence-to-decision tables used to develop recommendations for the pain group are available in Supplemental Table 3 (Supplemental Digital Content 4, ), and the forest plots for all meta-analyses are available in Supplemental Figure 1 (Supplemental Digital Content 5, ). | Risk Factors Question: What factors influence pain in critically

2018 Society of Critical Care Medicine

97. Midregional proadrenomedullin predicts mortality and major adverse cardiac events in patients presenting with chest pain: results from the CHOPIN trial. (PubMed)

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 (...) and MACE in all-comers with chest pain and has similar prediction in those with a noncardiac diagnosis. This exploratory analysis is primarily hypotheses-generating and future prospective studies to identify its utility in risk stratification should be considered.© 2015 by the Society for Academic Emergency Medicine.

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2015 Academic Emergency Medicine

98. Moderate Risk Acute Coronary Syndrome Management

Moderate Risk Acute Coronary Syndrome Management Moderate Risk Acute Coronary Syndrome Management 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 (...) based) ( ) or NSTEMI ST Depression >1 mm Symmetrical T-wave inversion in precordial leads (>0.2 mV) Dynamic ST segment and changes with pain Less interpretable EKG findings increasing risk that has cardiac origin s Paced Rhythm VI. Imaging: Echocardiogram may assist in risk stratification of a patient with active Most helpful if completely normal Helpful also if significantly abnormal with wall motion abnormality (unless prior MI in the same region) VII. Labs: Serum Troponin Serum at presentation

2018 FP Notebook

99. Low Risk Acute Coronary Syndrome Management

4 Low Risk Acute Coronary Syndrome Management Low Risk Acute Coronary Syndrome Management Aka: Low Risk Acute Coronary Syndrome Management , Non-diagnostic Electrocardiogram Protocol , Non-diagnostic EKG Protocol , Atypical Chest Pain , Low Risk Chest Pain From Related Chapters II. Indications: Electrocardiogram (EKG) suggestive of Low Risk Chest Pain Normal or unchanged ST Depression 0.5 to 1.0 mm inversion (<0.2 mV) or flattening Leads with dominant III. Contraindications: Moderate Risk (...) for ischemia References Orman, Mattu and Swaminathan in Herbert (2016) EM:Rap 16(10): 8-9 VII. Evaluation Initial evaluation for high risk, intermediate risk and Low Risk Chest Pain begins the same See (includes giving 325 mg) Low Risk Chest Pain protocol is only per indications listed above Approach Assess likelihood Consider differential diagnosis Decision Rules See (may be preferred for accelerated diagnostic protocols) See Precautions s are not useful in the exclusion of acute coronary disease

2018 FP Notebook

100. Myocardial Ischemia - Nuclear Medicine and Risk Stratification

, determining this probability is important for increasing the test’s clinical value. In their landmark CAD risk analysis article, Diamond and Forrester described the relationship between clinical symptoms and angiographically significant CAD. [ ] The authors described 3 types of chest pain: nonanginal, atypical, and typical. The benefit of their categorization is the ease of its use and its powerful risk stratification. Disease is categorized on the basis of 3 symptoms, which are assessed (...) . For example, a man in his 30s with nonanginal chest pain has a relatively low risk of CAD (approximately 5%); however, if the pain is typical, the risk is higher (70%) (see the image below). The risk of coronary artery disease (CAD) can quickly be stratified by determining whether the patient's pain is nonanginal, atypical, or typical. For men in their 30s with nonanginal chest pain, the pretest probability of disease is approximately 5%; however, men in their 30s with typical chest pain have a 70

2014 eMedicine Radiology

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