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Coronary Risk Stratification of Chest Pain

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101. 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

102. 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

103. 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

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. The PressureWire fractional flow reserve measurement system for coronary artery disease

that are visible on angiogram. Stable angina occurs when the blood flow to the heart is restricted by a narrowing of the coronary arteries. It causes chest pain after physical exercise or stress. There is a risk that it may lead to acute coronary syndrome, including unstable angina and myocardial infarction. In myocardial The PressureWire fractional flow reserve measurement system for coronary artery disease (MIB2) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms (...) -and- conditions#notice-of-rights). Page 21 of 51Inclusion/ exclusion criteria Inclusion criteria: Stable angina, or atypical / no chest pain but documented ischaemia on non- invasive testing At least one stenosis =50% in native coronary artery with diameter =2.5mm, supplying viable myocardium Eligible for PCI Exclusion criteria: Preferred treatment is CABG Left main coronary artery disease needing revascularisation Patients with a recent STEMI or non-STEMI ( 80 years, chronic occlusion of one of the non

2014 National Institute for Health and Clinical Excellence - Advice

106. 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

107. 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

108. 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

109. Mind the gap on ACS and the TIMI risk score

syndrome? (4:08) Clinical context matters – angina pectoris, atypical chest pain, and troponins (5:22) You can’t just “cath” everyone – risk stratification to identify patients with high mortality risk (9:42) TIMI isn’t perfect – the issues with the score and MACE outcomes (14:00) Review of teaching points (17:58) For a transcript of the podcast and show notes: For more from Core IM: Subscribe to for the latest updates! Follow us on Facebook || Twitter || Instagram . Please give any feedback (...) Task Force on Practice Guidelines. J Am Coll Cardiol. 2014 Dec 23;64(24):e139-e228. Fred HL. Atypical chest pain: a typical humpty dumpty coinage. Tex Heart Inst J. 2009;36(5):373-4. Lee TH, Cook EF, Weisberg M, et al. Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med. 1985; 145:65–9. Tavakol M, Ashraf S, Brener SJ. Risks and complications of coronary angiography: a comprehensive review. Glob J Health Sci. 2012;4(1):65-93. Hamm CW

2019 Clinical Correlations

110. 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

111. 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

112. 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

113. Canadian Cardiovascular Society Guidelines on perioperative cardiac risk assessment and management for patients who undergo noncardiac surgery

, cardiopulmonary testing) will Table 1. Computation of Revised Cardiac Risk Index score Variable Points History of ischemic heart disease* 1 History of congestive heart failure y 1 History of cerebrovascular disease z 1 Use of insulin therapy for diabetes 1 Preoperative serum creatinine> 177 mmol/L (> 2.0 mg/dL) 1 High-risk surgery x 1 ECG, electrocardiogram. *De?ned as a history of myocardial infarction, positive exercise test, current complaint of ischemic chest pain or nitrate use, or ECG with path (...) Index score 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against theinitiationorcontinuationofacetylsalicylicacidforthepreventionof perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against a 2

2017 CPG Infobase

114. 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

115. 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

116. 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

117. 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

2018 American Heart Association

118. 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

119. 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

120. Cardiac Magnetic Resonance Imaging Strategy for the Management of Patients With Acute Chest Pain and Detectable to Elevated Troponin

pain Cardiac MRI Risk Stratification Emergency Department Elevated Troponin Troponin Non-ST Elevation Myocardial Infarction Additional relevant MeSH terms: Layout table for MeSH terms Acute Coronary Syndrome Chest Pain Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Pain Neurologic Manifestations Signs and Symptoms (...) objective is to improve outcomes by optimizing healthcare delivery processes for patients with detectable to elevated serum troponin. This clinical trial involving emergency department (ED) patients with intermediate to high-risk chest pain and detectable to minimally elevated serum troponin within 6 hours of evaluation. Condition or disease Intervention/treatment Phase Acute Coronary Syndrome Chest Pain Procedure: Cardiac MRI Other: ACC/AHA Guideline adherent care Not Applicable Detailed Description

2013 Clinical Trials

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