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Coronary Risk Stratification of Chest Pain

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101. 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

102. 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

103. 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

104. Management of Opioid Therapy (OT) for Chronic Pain

Therapy B. Module B: Treatment with Opioid Therapy C. Module C: Tapering or Discontinuation of Opioid Therapy D. Module D: Patients Currently on Opioid Therapy V. Background A. Opioid Epidemic B. Paradigm Shift in Pain and Its Treatment C. Prioritizing Safe Opioid Prescribing Practices and Use D. Taxonomy E. Epidemiology and Impact F. Chronic Pain and Co-occurring Conditions G. Risk Factors for Adverse Outcomes of Opioid Therapy VI. About this Clinical Practice Guideline A. Scope of this Clinical (...) ui d el i n e f o r O p ioid T h e r a p y for Ch r on ic Pa in February 2017 Page 4 of 198 B. Risk Mitigation 46 51 70 71 75 75 75 80 81 81 88 99 100 105 105 110 116 116 120 122 C. Type, Dose, Duration, Follow-up, and Taper of Opioids D. Opioid Therapy for Acute Pain Appendix A: VA Signature Informed Consent Appendix B: Urine Drug Testing A. Benefits of Urine Drug Testing B. Types of Urine Drug Testing Appendix C: Diagnostic and Statistical Manual of Mental Disorders for Opioid Use Disorders

2017 VA/DoD Clinical Practice Guidelines

105. How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain? (PubMed)

How useful are the Heart Foundation risk criteria for assessment of emergency department patients with chest pain? To investigate the prognostic utility of Heart Foundation (Australia) risk stratification table in an ED chest pain population.A planned sub-study of a prospective observational study of adult patients with potentially cardiac chest pain who underwent evaluation for acute coronary syndrome (ACS) was conducted. Data collected included demographical, clinical, ECG, biomarker (...) only fair predictive performance for MI, 7 and 30 day MACE. With specificity of approximately 50%, the recommendation for coronary care admission for all high-risk patients is hard to justify.© 2012 The Author. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

2012 Emergency medicine Australasia

106. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations.

. et al. Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest . 2012 ; 141 : e326S–e350S ) (15) . Finally, other patient-related factors can affect risk: many types of cancer increase thrombosis risk ( x 16 Bick, R.L. Cancer-associated thrombosis. N Engl J Med . 2003 ; 349 : 109–111 ) (16) , as do obesity, hormone-replacement therapy, long-term (...) of thrombotic risk, especially when newly implanted ( x 18 Dangas, G.D., Weitz, J.I., Giustino, G., Makkar, R., and Mehran, R. Prosthetic heart valve thrombosis. J Am Coll Cardiol . 2016 ; 68 : 2670–2689 ) (18) . Coronary Artery Disease As discussed in part I of these guidelines, significant morbidity and potential for thromboembolic complications exist if such patients are mismanaged ( x 20 Windecker, S., Kolh, P., Alfonso, F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: the Task Force

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2019 Society of Interventional Radiology

107. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations

of gastrointestinal and platelet effects. Arthritis Rheum . 1998 ; 41 : 1591–1602 ). NSAIDs are typically taken electively for pain control and can be discontinued without negatively affecting cardiac or cerebrovascular thromboembolic risk ( x 31 Narouze, S., Benzon, H.T., Provenzano, D. et al. Interventional spine and pain procedures in patients on antiplatelet and anticoagulant medications (second edition): guidelines from the American Society of Regional Anesthesia and Pain Medicine, the European Society (...) of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med . 2018 ; 43 : 225–262 ) (31) . Studies on patients undergoing interventional procedures while receiving NSAIDs are limited and inconclusive ( x 32 Endres, S., Shufelt, A., and Bogduk, N. The risks of continuing or discontinuing anticoagulants for patients undergoing common interventional

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2019 Society of Interventional Radiology

108. Breast Cancer: Medication Use to Reduce Risk

, musculoskeletal pain, and possible cardiovascular events, such as stroke. Aromatase inhibitors do not reduce, and may even increase, risk of fractures. USPSTF Assessment The USPSTF concludes with moderate certainty that there is a moderate net benefit from taking tamoxifen, raloxifene, or aromatase inhibitors to reduce risk of invasive breast cancer in women at increased risk. The USPSTF concludes with moderate certainty that the potential harms of taking tamoxifen, raloxifene, and aromatase inhibitors (...) or lobular carcinoma in situ on a prior biopsy. Women with documented pathogenic mutations in the breast cancer susceptibility 1 and 2 genes ( BRCA1/2 ) and women with a history of chest radiation therapy (such as for treatment of childhood or adolescent Hodgkin or non-Hodgkin lymphoma) are at especially high risk for breast cancer. The cumulative absolute risk of developing breast cancer in a woman who received chest radiation at age 25 years increases from an estimated 1.4% at age 35 years

2019 U.S. Preventive Services Task Force

109. Risk factors for breast cancer: A review of the evidence 2018

Risk factors for breast cancer: A review of the evidence 2018 Risk factors for breast cancer: A review of the evidence 2018 Breast cancer risk factors: A review of the evidence i Risk factors for breast cancer: A review of the evidence was prepared and produced by: Cancer Australia Locked Bag 3 Strawberry Hills NSW 2012 Australia Tel: +61 2 9357 9400 Fax: +61 2 9357 9477 canceraustralia.gov.au © Cancer Australia 2018. ISBN Print: 978–1–74127–336–6 ISBN Online: 978–1–74127–337–3 Recommended (...) citation Cancer Australia, 2018. Risk factors for breast cancer: A review of the evidence, Cancer Australia, Surry Hills, NSW. Risk factors for breast cancer: A review of the evidence can be downloaded from the Cancer Australia website: canceraustralia.gov.au Copyright statements Internet sites This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within

2018 Cancer Australia

110. 2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease

2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease 2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease | Circulation Search Hello Guest! Login to your account Email Password Keep me logged in Search March 2019 March 2019 March 2019 March 2019 March 2019 February (...) 2019 February 2019 February 2019 February 2019 January 2019 January 2019 January 2019 January 2019 January 2019 This site uses cookies. By continuing to browse this site you are agreeing to our use of cookies. Free Access article Share on Jump to Free Access article 2013 ACCF/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Acute Coronary Syndromes and Coronary Artery Disease A Report of the American College of Cardiology Foundation/American

2013 American Heart Association

111. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

ethnicities (NHWs, Asians, Hispanics, and blacks), Asian Indians were investigated for coronary artery calcification (CAC) burden compared with the other racial/ethnic groups. Asian Indians, who represented ≈10% of the cohort, had an increased mean calcium score, and the Asian Indian race was a significant independent predictor of CAC severity, even when controlling for traditional ASCVD risk factors. Among those >60 years of age, the prevalence of high CAC burden (scores >100) in Asian Indians is greater (...) than in all other ethnic groups. The MASALA study (Mediators of Atherosclerosis in South Asians Living in America) is still in its infancy in terms of long-term follow-up but has used methods including CAC and carotid intimal-medial thickness (CIMT) estimation by ultrasound to predict cardiovascular events. CIMT can help to visualize and quantify subclinical atherosclerosis and has the potential of being an additional risk stratification tool. Within the MASALA cohort, preliminary data showed

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2018 American Heart Association

112. Transcatheter aortic valve implantation (TAVI) in patients at intermediate surgical risk

. Payment models in 2013 31 Table 4.1. Surgical risk for 30-day mortality in patient stratification for SAVR and TAVI. 33 Table 4.2. Reimbursement status of TAVI among EUnetHTA partners 36 Table 5.1. Summary of findings for the efficacy comparison of TAVI compared with SAVR for patients with aortic stenosis at intermediate surgical risk 44 Table 6.1. Summary of findings for the safety comparison of TAVI compared with SAVR for patients with aortic stenosis at intermediate surgical risk 56 Table 7.1 (...) between October and November 2017 among EUnetHTA partners showed that TAVI was reimbursed in all 20 responding countries and regions. However, decisions about reimbursement in patients at intermediate risk were pending in some countries (A0011). The comparators In most patients, SAVR is the first choice of treatment for severe symptomatic aortic valve stenosis. SAVR is performed under general anaesthesia via an incision in the chest (thoracotomy), through different approaches. Level of invasiveness

2018 EUnetHTA

113. Coronary atherosclerosis imaging by CT to improve clinical outcomes. (PubMed)

of outcomes after CCTA in patients with acute chest pain and asymptomatic patients. In addition, more advanced quantification of plaque subtypes, vascular inflammation and coronary flow dynamics may identify further patients at increased risk.Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved. (...) Coronary atherosclerosis imaging by CT to improve clinical outcomes. Coronary artery disease remains an important cause of morbidity and mortality world-wide. Coronary Computed Tomography Angiography (CCTA) has excellent diagnostic accuracy and the identification and stratification of coronary artery disease is associated with improved prognosis in multiple studies. Recent randomized controlled trials have shown that in patients with stable coronary artery disease, CCTA is associated

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2019 Journal of cardiovascular computed tomography

114. Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke. (PubMed)

patients without cardiac symptoms.From January 2013 to December 2014, 762 ischemic stroke patients with risk factors for CAD and without chest pain underwent coronary computed tomography angiography. CACS, CAD extent classification, and CAD-RADS scores were used to evaluate the computed tomography angiography images. The primary endpoint was major adverse cardiovascular events (MACEs), which were defined as cardiovascular death, nonfatal myocardial infarction, unstable angina requiring hospitalization (...) Prognostic value of coronary artery disease-reporting and data system (CAD-RADS) score for cardiovascular events in ischemic stroke. The coronary artery disease-reporting and data system (CAD-RADS) was recently developed to standardize CAD classifications and incorporate clinical management. We aimed to investigate the prognostic value and additional risk stratification benefits of CAD-RADS compared to coronary artery calcium scores (CACS) and CAD extent classifications in ischemic stroke

2019 Atherosclerosis

115. Microcirculation function assessed by adenosine triphosphate stress myocardial contrast echocardiography and prognosis in patients with nonobstructive coronary artery disease. (PubMed)

with nonobstructive coronary artery disease (CAD).From 2006 to 2014, 227 consecutive patients with chest pain and a diagnostic coronary angiography without significant coronary artery stenosis (<50%) who underwent adenosine triphosphate disodium (ATP) stress MCE were enrolled. Quantitative MCE measurements were analyzed using replenishment curves.Median follow-up time of this study was 5.3 years. Predictors of impaired coronary flow reserve (CFR) were smoking, diabetes, high apolipoprotein B, high low-density (...) [CI]: 3.01-182.32; P = .003), β reserve ≤1.6 (OR = 29.96, 95% CI: 3.5-241.27; P = .002), and diabetic (OR = 33.11, 95% CI: 3.65-300.02; P = .002) significantly increased the risk of the primary endpoint events.ATP stress quantitative MCE is a feasible and effective method to evaluate microcirculation abnormalities in human coronary arteries and it can be used for the clinical analysis, risk stratification, and treatment of early CAD.

2019 Medicine

116. Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging. (PubMed)

Value of reserve pulse pressure in improving the risk stratification of patients with normal myocardial perfusion imaging. To evaluate the incremental prognostic value of reserve-pulse pressure (reserve-PP: exercise-PP minus rest-PP) to standard risk factors among patients with suspected coronary artery disease (CAD) but normal exercise myocardial perfusion imaging (MPI).We studied 4269 consecutive symptomatic patients without known CAD who were referred for exercise MPI but had normal MPI (...) results (mean age 58 ± 12 years, 56% females, 84% referred for evaluation of chest pain or dyspnoea, 95% with intermediate pretest likelihood of CAD). There were 202 deaths over 5.1 ± 1.4 years of follow-up. Reserve-PP was abnormal (<44 mmHg increase in PP from rest) in 1894 patients (44%). Patients with an abnormal reserve-PP had a higher risk of death compared with patients with normal reserve-PP [hazard ratio (HR): 2.47, 95% CI, 1.8-3.3]. In multivariable models adjusting for age, sex, ejection

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2013 European Heart Journal

117. Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone? (PubMed)

chest pain admitted thorough the emergency department. None had prior coronary artery disease. CACS was calculated using the Agatston method. EATv and ITFv were semiautomatically calculated. Median patient follow-up was 3.3 years. Mean patient age was 54.4±13.7 years and Framingham risk score 8.2±8.2. The 45 patients (5.9%) with major acute cardiac events (MACE) were older (64.8±13.9 versus 53.7±13.4 years), more frequently male (60% versus 40%), and had a higher median Framingham risk score (16 (...) Does quantifying epicardial and intrathoracic fat with noncontrast computed tomography improve risk stratification beyond calcium scoring alone? Noncontrast cardiac computed tomography allows calculation of coronary artery calcium score (CACS) and measurement of epicardial adipose tissue (EATv) and intrathoracic fat (ITFv) volumes. It is unclear whether fat volume information contributes to risk stratification.Cardiac computed tomography was performed in 760 consecutive patients with acute

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2013 Circulation. Cardiovascular imaging

118. 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)

119. CCS guidelines on perioperative cardiac risk assessment and management for patients undergoing noncardiac surgery

heart failure † 1 History of cerebrovascular disease ‡ 1 Use of insulin therapy for diabetes 1 Preoperative serum creatinine > 177 μmol/L (> 2.0 mg/dL) 1 High-risk surgery 1 ECG, electrocardiogram. Defined as a history of myocardial infarction, positive exercise test, current complaint of ischemic chest pain or nitrate use, or ECG with pathological Q waves; patients with previous coronary bypass surgery or angioplasty meet criteria if they have such findings after their procedure. Defined (...) : August 4, 2016 ; | Figure 1 Preoperative risk assessment and postoperative monitoring flow diagram. BNP, brain natriuretic peptide; ECG, electrocardiogram; NT-proBNP, N-terminal pro-brain natriuretic peptide; PACU, postanesthesia care unit; PHTN, pulmonary hypertension; RCRI, Revised Cardiac Risk Index. ∗ Significant cardiovascular disease includes known history of coronary artery disease, cerebral vascular disease, peripheral artery disease, congestive heart failure, severe PHTN or a severe

2016 Canadian Cardiovascular Society

120. Computed Tomography for Suspected Coronary Artery Disease

reserve: Implications for myocardial contrast echocardiography versus radionuclide perfusion imaging for the detection of coronary artery disease. Circulation 2008;117:1832-41. Douglas PS, Ginsburg GS. The evaluation of chest pain in women. N Engl J Med 1996;334:1311-5. Lerner DJ, Kannel WB. Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 1986;111:383-90. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF (...) outcomes after both coronary calcium scanning and exercise myocardial perfusion scintigraphy. J Am Coll Cardiol 2007;49:1352-61. Shaw LJ, Berman DS, Hendel RC, Alazraki N, Krawczynska E, Borges-Neto S, et al. Cardiovascular disease risk stratification with stress single-photon emission computed tomography technetium-99m tetrofosmin imaging in patients with the metabolic syndrome and diabetes mellitus. Am J Cardiol 2006;97:1538-44. Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al

2011 Swedish Council on Technology Assessement

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