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Coronary Risk Stratification of Chest Pain

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81. Evaluation and outcomes of patients admitted to a tertiary medical assessment unit with acute chest pain of possible coronary origin. (PubMed)

Evaluation and outcomes of patients admitted to a tertiary medical assessment unit with acute chest pain of possible coronary origin. The study aims to (i) profile clinical characteristics, risk estimates of acute coronary syndrome (ACS), use and yield of non-invasive cardiac testing, discharge diagnosis and 30-day outcomes among patients admitted with acute chest pain of possible coronary origin; and (ii) construct a risk stratification algorithm that informs management decisions.This (...) is a retrospective cohort study of 130 consecutive patients admitted to a tertiary hospital medical assessment unit between 24 January and 22 March 2012. Estimates of ACS risk were based on Australian guidelines and Thrombolysis in Myocardial Infarction (TIMI) scores.Patients were of mean age 61 years, 45% had known coronary artery disease (CAD), 58% presented with typical ischaemic pain, 82% had intermediate to high ACS risk and 61% underwent testing. Myocardial ischaemia was cardiologist-confirmed discharge

2013 Emergency medicine Australasia

82. Increased urinary IgM excretion in patients with chest pain due to coronary artery disease. (PubMed)

 mg/mmol) had a 3-fold higher risk for cardiovascular new events compared to patients with low IgM-uria (RR = 3.3, 95% CI: 1.1 - 9.9, p = 0.001).In patients with chest pain, an increased urine IgM excretion, is associated with coronary artery disease and long-term cardiovascular complications. Measuring urine IgM concentration could have a clinical value in risk stratification of patients with ACS. (...) Increased urinary IgM excretion in patients with chest pain due to coronary artery disease. Micro-albuminuria is a recognized predictor of cardiovascular morbidity and mortality in patients with coronary artery disease. We have previously reported, in diabetic and non-diabetic patients, that an increased urinary excretion of IgM is associated with higher cardiovascular mortality. The purpose of this study was to investigate the pattern of urinary IgM excretion in patients with acute coronary

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2013 BMC Cardiovascular Disorders

83. Are Serial Electrocardiograms Additive to SeriAl Second-generations Troponins in Predicting Acute CoronAry Syndromes in PatienTs With Undifferentiated cHest Pain

: February 2018 Keywords provided by Wake Forest University Health Sciences: Acute Coronary Syndrome Chest pain Electrocardiograms Risk Stratification Emergency Department Additional relevant MeSH terms: Layout table for MeSH terms Syndrome Acute Coronary Syndrome Chest Pain Disease Pathologic Processes Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Pain Neurologic Manifestations Signs and Symptoms (...) electrocardiogram (ECG) changes aids in reclassifying participants' risk for major adverse cardiac events (MACE) over and above serial blood testing. Condition or disease Intervention/treatment Acute Coronary Syndrome Chest Pain Device: Serial Electrocardiograms Detailed Description: Chest pain is one of the most common symptoms evaluated in the Emergency Department (ED). One of the primary diagnostic concerns during the evaluation of this presentation is whether there is evidence of acute coronary syndromes

2013 Clinical Trials

84. 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

85. 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

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. 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

88. Acute coronary syndrome

coronary intervention 20 6 Risk stratification and non-invasive testing 22 6.1 Risk stratification 22 6.2 Assessment of cardiac function 22 6.3 Stress testing 23 7 Invasive investigation and revascularisation 24 7.1 Invasive investigation 24 7.2 Access routes for percutaneous coronary intervention 25 7.3 Glycoprotein IIb/IIIa receptor antagonists 26 7.4 Coronary artery bypass grafting surgery 26 8 Early pharmacological intervention 28 8.1 Antiplatelet therapy 28 8.2 Anticoagulant therapy 29 8.3 Statin (...) the management of undifferentiated chest pain or acute heart failure although the treatment of hypoxia and cardiogenic shock in patients with ACS is considered in section 9. 1.2.2 DEFINITION OF ACUTE CORONARY SYNDROME Acute coronary syndrome encompasses a spectrum of unstable coronary artery disease from unstable angina to transmural myocardial infarction. All have a common aetiology in the formation of thrombus on an inflamed and complicated atheromatous plaque. The principles behind the presentation

2016 SIGN

89. 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

90. Coronary endothelial function testing provides superior discrimination compared to standard clinical risk scoring in prediction of cardiovascular events (PubMed)

% of patients [NRI 0.12 (95% CI -0.02 to 0.26)], and the combined microvascular and epicardial CEF correctly reclassified 22.8% of patients [NRI 0.23 (95% CI 0.08-0.37)].CEF testing is safe and adds value to the FRS, with superior discrimination and risk stratification compared with FRS alone in patients presenting with chest pain or suspected ischemia. (...) was evaluated using intracoronary acetylcholine in 470 patients who presented with chest pain and nonobstructive coronary artery disease. CV events were assessed after a median follow-up of 9.7 years. The association between CEF and CV events was examined, and the net reclassification improvement index (NRI) was used to compare the incremental contribution of CEF when added to FRS.The mean age was 53 years, and 68% of the patients were women with a median FRS of 8. Complications (coronary dissection

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2016 Coronary artery disease

91. 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

92. 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

93. Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease

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 (...) in an indication, especially when high and intermediate risk are used in the indication. View this table: Table A Revascularization to Improve Survival Compared With Medical Therapy View this table: Table B Noninvasive Risk Stratification Vessel Disease The construct used to characterize the extent of CAD is based on the common clinical use of the terms 1-, 2-, and 3-vessel disease and left main disease, although it is recognized that individual coronary anatomy is highly variable. In general, these terms

2017 Society for Cardiovascular Angiography and Interventions

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

, Stephen Woodruffe, Alistair Kerr, Maree Branagan and Philip EG Aylward Med J Aust 2016; 205 (3): . || doi: 10.5694/mja16.00368 Published online: 1 August 2016 Topics Abstract Introduction: The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented (...) on the: diagnosis and risk stratification of ACS; provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST segment elevation myocardial infarction; risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS; administration of antithrombotic therapies in the acute setting and considerations affecting their long term use; and implementation of an individualised secondary prevention plan that includes

2016 MJA Clinical Guidelines

95. 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

96. Acute Coronary Syndromes: Overview & Summary

February 2011 SUMMARY OF THE GUIDELINES Guideline 14 Introduction to Acute Coronary Syndromes (ACS) Guideline 14.1 Presentation with ACS ? Symptoms and Signs ? The 12 lead ECG ? Cardiac Biomarkers ? Decision Rules ? Chest Pain Observation Units (CPUs) ? Imaging Guideline 14.2 Initial Medical Therapy ? Oxygen and analgesia ? Anti platelet agents and Anticoagulants ? Optimal Medical Therapy for Primary and Secondary Prevention Guideline 14.3 Reperfusion Strategy ? Introduction ? Primary Percutaneous (...) for an acute coronary syndrome is reducing the delay from symptom onset to first medical contact and then initiation of targeted treatment. There are then real potential opportunities for improving survival in the out of hospital phase and emergency phase of care pathway 7 . This is evidenced by the fact that although in hospital from NSTEMI has been reducing significantly by improved reperfusion therapy and optimal medical therapy including risk factor modification, mortality for STEMI is virtually

2016 Australian Resuscitation Council

97. Acute Coronary Syndromes: Presentation with ACS

Laboratory Medicine Practice Guidelines: analytical issues for biochemical markers of acute coronary syndromes. Clin Chem 2007;53:547-51. 50. Lee-Lewandrowski E, Januzzi JL, Green SM, et al. Multi-center validation of the Response Biomedical Corporation RAMP NT-proBNP assay with comparison to the Roche Diagnostics GmbH Elecsys proBNP assay. Clin Chim Acta 2007;386:20-4. 51. Apple FS, Jaffe AS. Bedside multimarker testing for risk stratification in chest pain units: The chest pain evaluation by creatine (...) acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med 2006;13:13-8. 54. Soiza RL, Leslie SJ, Williamson P, et al. Risk stratification in acute coronary syndromes--does the TIMI risk score work in unselected cases? QJM 2006;99:81-7. 55. Jaffery Z, Hudson MP, Jacobsen G, Nowak R, McCord J. Modified thrombolysis in myocardial infarction (TIMI) risk score to risk stratify patients in the emergency department with possible acute coronary syndrome. J Thromb

2016 Australian Resuscitation Council

98. 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

99. 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

100. 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

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