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Coronary Risk Stratification of Chest Pain

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121. Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. (PubMed)

; 95% confidence interval, 2.15-7.72; P<0.001) and advancing age (hazard ratio, 1.78; 95% confidence interval, 1.39-2.37; P<0.001) predicted hard events in multivariable regression analysis.SE incorporated into a chest pain unit has excellent feasibility and provides rapid assessment and discharge with accurate risk stratification of patients with suspected acute coronary syndrome but nondiagnostic ECG and negative 12-hour troponin. (...) Incremental diagnostic and prognostic value of contemporary stress echocardiography in a chest pain unit: mortality and morbidity outcomes from a real-world setting. Clinical assessment often cannot reliably or rapidly risk stratify patients hospitalized with suspected acute coronary syndrome. The real-world clinical value of stress echocardiography (SE) in these patients is unknown. Thus, we undertook this study to assess the feasibility, safety, ability for early triaging, and prediction

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2013 Circulation. Cardiovascular imaging

122. Utility of 14 novel biomarkers in patients with acute chest pain and undetectable levels of conventional cardiac troponin. (PubMed)

Utility of 14 novel biomarkers in patients with acute chest pain and undetectable levels of conventional cardiac troponin. Patients with acute chest pain having serial undetectable cardiac troponin (cTn) levels, as measured with conventional assays, are considered at very low risk. The aim of this multicenter study was to determine the accuracy of multiple biomarkers in these patients.We enrolled 1247 consecutive patients with suspected AMI. Of these, 325 had undetectable levels of cTnT (Roche (...) the receiver-operating characteristics curve to predict death/AMI was 0.73 (95%CI 0.63-0.83) for hs-cTnT, 0.71 (95% CI 0.62-0.81) for MR-proADM and 0.78 (95%CI 0.71-0.86) for GDF-15.Patients with serial undetectable levels of cTnT using the contemporary 4th generation assay are at low but not negligible risk of future cardiac events. Hs-cTnT, MR-proADM and/or GDF-15 might help to further improve risk-stratification in this group.Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

2013 International journal of cardiology

123. 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

124. Shared Decision Making in the Emergency Department: Chest Pain Choice Trial

arm (no decision aid used) Outcome Measures Go to Primary Outcome Measures : Test if Chest Pain Choice Safely Improves Patient Knowledge. [ Time Frame: Directly following intervention (on day 1) ] Patient knowledge was measured by immediate post-visit survey that included 8 questions about the patient's risk for acute coronary syndrome and the available management options. Secondary Outcome Measures : Test if the Decision Aid Has an Effect on Healthcare Utilization Within 30 Days After Enrollment (...) of cardiac testing, and total healthcare utilization. Condition or disease Intervention/treatment Phase Chest Pain Acute Coronary Syndrome Other: Chest Pain Choice Decision Aid Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Actual Enrollment : 898 participants Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double (Investigator, Outcomes Assessor) Primary Purpose: Health Services Research Official Title: Shared

2013 Clinical Trials

125. Pharmacotherapy in Chronic Kidney Disease Patients Presenting With Acute Coronary Syndrome

with advanced CKD and dialysis were less likely to have chest pain on admission (40.4% and 41.1%, respectively) than those without CKD (61.6%). Similar observations were made in the SWEDEHEART registry [Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies]; however, up to two thirds of patients with stage 4 and 5 CKD in that registry had chest pain at presentation. 15 The USRDS-NRMI study also showed that MI patients (...) =9935), 60–89 (n=20 135), 30–59 (n=11 103), 15–29 (n=1273), and 2+ proteinuria or SCr >1.5 times the upper limit of normal, subgroup analysis of those with mild renal insufficiency (CrCl = 75 mL/min) found that pravastatin reduced the risk of death of coronary disease or symptomatic nonfatal MI by 28% (adjusted HR, 0.72; 95% CI, 0.55–0.95; P=0.02) among patients with AMI between 3 and 20 months before randomization (Table 10). 135 The analy- sis also found that adverse events were infrequent among

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2015 American Heart Association

126. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes

care AHA 2010 Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure NHLBI 2003 Statements Key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease ACC/AHA 2013 Practical clinical considerations in the interpretation of troponin elevations ACC 2012 Testing of low-risk patients presenting to the emergency department with chest pain AHA (...) ) risk score, the GRACE (Global Registry of Acute Coronary Events) risk score, and the NCDR-ACTION (National Cardiovascular Data Registry-Acute Coronary Treatment and Intervention Outcomes Network) registry ( ). These assessment tools have been applied with variable efficacy to predict outcomes in patients presenting to the emergency department (ED) with undifferentiated chest pain (“pain” encompasses not only pain, but also symptoms such as discomfort, pressure, and squeezing). The Sanchis score

2014 American Heart Association

127. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: Executive Summary

Stratification Figure 2. Global Registry of Acute Coronary Events Risk Calculator for In-Hospital Mortality for Acute Coronary Syndrome. Class I In patients with chest pain or other symptoms suggestive of ACS, a 12-lead electrocardiogram (ECG) should be performed and evaluated for ischemic changes within 10 minutes of the patient’s arrival at an emergency facility. (Level of Evidence: C ) If the initial ECG is not diagnostic but the patient remains symptomatic and there is a high clinical suspicion for ACS (...) or Outpatient Facility Presentation 2358 3.3. Prognosis–Early Risk Stratification 2359 3.4. Cardiac Biomarkers and the Universal Definition of Myocardial Infarction 2362 3.4.1. Biomarkers: Diagnosis 2362 3.4.2. Biomarkers: Prognosis 2363 3.5. Discharge From the ED or Chest Pain Unit 2363 Early Hospital Care: Recommendations 2363 4.1. Standard Medical Therapies 2363 4.1.1. Oxygen 2363 4.1.2. Nitrates 2363 4.1.3. Analgesic Therapy 2364 4.1.4. Beta-Adrenergic Blockers 2364 4.1.5. Calcium Channel Blockers 2365

2014 American Heart Association

128. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

identify a proximal aortic dissection. In low-risk patients with chest pain, coronary CT angiography can result in a more rapid, more cost-effective diagnosis than stress myocardial perfusion imaging (66). 3.3. Prognosis—Early Risk Stratification: Recommendations See Table 4 for a summary of recommendations from this section. Class I 1. In patients with chest pain or other symptoms suggestive of ACS, a 12-lead ECG should be performed and evaluated for ischemic changes within 10 minutes of the patient’s (...) 4.4.6. Care Objectives 51 4.5. Risk Stratification Before Discharge for Patients With an Ischemia-Guided Strategy of NSTE-ACS: Recommendations 52 4.5.1. Noninvasive Test Selection 53 4.5.2. Selection for Coronary Angiography 53 5. Myocardial Revascularization 54 5.1. Percutaneous Coronary Intervention 54 5.1.1. PCI—General Considerations: Recommendation 54 5.1.2. PCI—Antiplatelet and Anticoagulant Therapy 55 5.1.2.1. Oral and Intravenous Antiplatelet Agents: Recommendations 55 5.1.2.2. GP IIb/IIIa

2014 Society for Cardiovascular Angiography and Interventions

129. Management of Stable Coronary Artery Disease

of stable coronary artery disease. 2956 Table 4 Traditional clinical classi?cation of chest pain 2957 Table 5 Classi?cation of angina severity according to the Canadian Cardiovascular Society 2958 Table 6 Traditional clinical classi?cation of chest pain 2959 Table 7 Blood tests for routine re-assessment in patients with chronic stable coronary artery disease 2959 Table 8 Resting electrocardiogram for initial diagnostic assessment of stable coronary artery disease 2960 Table 9 Echocardiography 2960 Table (...) 10 Ambulatory electrocardiogram monitoring for initial diagnostic assessment of stable coronary artery disease 2961 Table 11 Chest X-ray for initial diagnostic assessment of stable coronary artery disease 2961 Table 12 Characteristics of tests commonly used to diagnose the presence of coronary artery disease 2962 Table 13 Clinical pre-test probabilities in patients with stable chest pain symptoms 2962 Table 14 Performing an exercise electrocardiogram for initial diagnostic assessment of angina

2013 European Society of Cardiology

130. Study of the Prediction of Acute Kidney Injury in Children Using Risk Stratification and Biomarkers

the ability of potential therapeutic measures to be effective. The investigators' recent proposition of the renal angina construct aims to improve and expedite AKI diagnosis through use of risk stratification. An apt parallel is the profound outcome change that has been effected in acute coronary syndrome through targeted troponin measurements in patients with both risk factors and clinical symptoms of coronary ischemia. Novel AKI biomarkers will struggle to gain widespread use until their performance (...) Study of the Prediction of Acute Kidney Injury in Children Using Risk Stratification and Biomarkers Study of the Prediction of Acute Kidney Injury in Children Using Risk Stratification and Biomarkers - 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

2012 Clinical Trials

131. Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease 2

. Following CCTA, patients are hence unnecessarily tested using golden standard ICA-FFR. These ICAs often show no obstructive coronary stenosis and are therefore not followed by revascularization. The issues outlined raises the question of whether it is possible (1) to make a more precise risk stratification and consequently better selection of patients prior to CCTA and (2) to reduce the number of patients referred for unnecessary ICAs following CCTA. In patients with suspicion of coronary stenosis (...) lesions (ICA-QCA diameter stenosis). However, disagreement between FFR and QFR has been identified in up to 20% of all measurements. Acoustic detections of coronary stenosis from automatically recorded and analyzed heart sounds is a newly developed technology potentially useful for pre-test risk stratification before e.g. CCTA. One of these devices, the CADScor®System, has previously shown an area under the receiver operating characteristic curve (AUC of ROC) of 70-80% compared to conventional ICA-QCA

2018 Clinical Trials

132. Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. (PubMed)

Coronary computed tomographic imaging in women: An expert consensus statement from the Society of Cardiovascular Computed Tomography. This expert consensus statement from the Society of Cardiovascular Computed Tomography (SCCT) provides an evidence synthesis on the use of computed tomography (CT) imaging for diagnosis and risk stratification of coronary artery disease in women. From large patient and population cohorts of asymptomatic women, detection of any coronary artery calcium (...) that identifies females with a 10-year atherosclerotic cardiovascular disease risk of >7.5% may more effectively triage women who may benefit from pharmacologic therapy. In addition to accurate detection of obstructive coronary artery disease (CAD), CT angiography (CTA) identifies nonobstructive atherosclerotic plaque extent and composition which is otherwise not detected by alternative stress testing modalities. Moreover, CTA has superior risk stratification when compared to stress testing in symptomatic

2018 Journal of cardiovascular computed tomography

133. Characteristics and Outcomes of Patients Hospitalized With Suspected Acute Coronary Syndrome in Whom the Diagnosis is not Confirmed. (PubMed)

and compared this subgroup with true ACS patients. Of 2557 patients included, 9.0% were discharged with a non-ACS diagnosis such as nonspecific chest pain, myopericarditis, stress cardiomyopathy, hemodynamic disturbances, heart failure, myocardial, pulmonary or valvular disease, or others. Compared with true ACS patients, those with other diagnoses were younger, more often female, and had less cardiovascular risk factors. Both groups had comparable rates of nonchest pain presentation and similar (...) hemodynamic characteristics on admission. Non-ACS patients presented less often with Q waves or with ST-segment or T-wave changes and had a lower Global Registry of Acute Coronary Events score than true ACS patients. In-hospital (4.3 vs 4.0%, respectively, p = 0.834) and 6-month (5.4 vs 8.0%, respectively, p = 0.163) mortality rates were comparable in both groups. However, if patients in the non-ACS group were divided into subgroups with nonspecific chest pain (6.2% of total) or other diagnoses (2.8

2018 American Journal of Cardiology

134. Novel Risk Markers and Risk Assessments for Cardiovascular Disease. (PubMed)

Novel Risk Markers and Risk Assessments for Cardiovascular Disease. The use of risk markers has transformed cardiovascular medicine, exemplified by the routine assessment of troponin, for both diagnosis and assessment of prognosis in patients with chest pain. Clinical risk factors form the basis for risk assessment of cardiovascular disease and the addition of biochemical, cellular, and imaging parameters offers further refinement. Identifying novel risk factors may allow greater risk (...) in a separate cohort in most cases. Risk markers related to atherosclerosis, thrombosis, inflammation, cardiac injury, and fibrosis are introduced in the context of their pathophysiology. Rapidly developing new areas, such as assessment of micro-RNA, are also explored. Subsequently the prognostic ability of these risk markers in coronary artery disease, heart failure, and atrial fibrillation is discussed in detail.© 2017 American Heart Association, Inc.

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2017 Circulation Research

135. Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features. (PubMed)

a low pretest probability of acute coronary syndrome. The utility of exercise stress testing in young adults with chest pain suspected of acute coronary syndrome who have National Heart Foundation intermediate risk features was evaluated.A retrospective analysis of exercise stress testing performed on patients less than 40 years was evaluated. Patients were enrolled on a chest pain pathway and had negative serial ECGs and cardiac biomarkers before exercise stress testing to rule-out acute coronary (...) patient declined further investigations. Assuming this was a true positive exercise stress test, the incidence of true positive exercise stress testing would have been 0.097% (95% confidence interval: 0.079-0.115%) (one of 1027 patients).Routine exercise stress testing has limited value in the risk stratification of adults less than 40 years with suspected intermediate risk of acute coronary syndrome.© 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

2014 Emergency medicine Australasia

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

intracellular prostacyclin synthesis, which eventually impairs the release of tissue-type plasminogen activator. As chronic pain frequently coexists with mental stress, characterized by a hypercoagulable state, patients with chronic pain may be placed at an increased risk for 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 (...) . In individuals using aspirin 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 aspirin. The risk of bleeding while continuing aspirin needs to be weighed against the cardiovascular risks of stopping aspirin. Documentation of decision making is recommended. If a decision is made to discontinue chronic aspirin therapy, the time of discontinuation should

2015 American Society of Regional Anesthesia and Pain Medicine

137. Acute Pain Management: Scientific Evidence

of the intercostobrachial nerve during mastectomy does not decrease chest wall hypersensitivity ( N) (Level I [PRISMA]). 5. Cryoanalgesia of the intercostal nerves at the time of thoracotomy results in no improvement in acute pain but an increase in chronic pain (S) (Level I). 6. There is significant association between anxiety, pain catastrophising ( N) (Level III-2 SR), depression, psychological vulnerability and stress (N) (Level IV SR) and the subsequent development of chronic postsurgical pain. 7. Other risk (...) understanding of mechanisms that explain how acute pain can often lead to chronic pain (Gilron 2014; Shipton 2014b). Most patients will recover and return to their normal life after an acute injury or surgery, yet others will suffer chronic pain and long-lasting disabilities ( Lavand’homme 2011). There are many short-term and long-term consequences of inadequately treated acute pain. These include hyperglycaemia, insulin resistance, an increased risk of infection, decreased patient comfort and satisfaction

2015 Clinical Practice Guidelines Portal

138. What is the incidence of major adverse cardiac events in emergency department chest pain patients with a normal ECG, Thrombolysis in Myocardial Infarction score of zero and initial troponin <=99th centile: an observational study? (PubMed)

-study of a prospective observational study of adult patients with potentially cardiac chest pain who underwent evaluation for acute coronary syndrome in an urban teaching hospital. Adult patients with non-traumatic chest pain were eligible for inclusion. Those with ECG evidence of acute ischaemia or an alternative diagnosis were excluded. Data collected included demographic, clinical, ECG, biomarker and outcome data. Low risk was defined as a TIMI risk score of 0 and initial TnI ≤99th centile (...) What is the incidence of major adverse cardiac events in emergency department chest pain patients with a normal ECG, Thrombolysis in Myocardial Infarction score of zero and initial troponin <=99th centile: an observational study? To determine the rate of major adverse cardiac events (MACE) in patients assessed in an emergency department (ED) for chest pain with a non-ischaemic ECG, Thrombolysis in Myocardial Infarction (TIMI) score of 0 and initial troponin I (TnI) ≤99th centile.This was a sub

2012 Emergency Medicine Journal

139. Efficacy Evaluation of the HEART Pathway in Emergency Department Patients With Acute Chest Pain

, 2018 Last Verified: August 2018 Layout table for additional information Studies a U.S. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Keywords provided by Wake Forest University Health Sciences: Acute Coronary Syndrome Chest pain Risk Stratification HEART Pathway Emergency Department Additional relevant MeSH terms: Layout table for MeSH terms Emergencies Acute Coronary Syndrome Chest Pain Disease Attributes Pathologic Processes Myocardial Ischemia Heart Diseases (...) Sponsor: Wake Forest University Health Sciences Collaborator: American Heart Association Information provided by (Responsible Party): Wake Forest University Health Sciences Study Details Study Description Go to Brief Summary: Our research will examine a chest pain care strategy, called the HEART pathway, which is designed to correctly identify Emergency Department patients at high-risk for cardiovascular events, likely to benefit from further testing, and patients at very-low-risk for cardiovascular

2012 Clinical Trials

140. Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department (PubMed)

Consumption of diagnostic procedures and other cardiology care in chest pain patients after presentation at the emergency department The HEART score serves risk stratification of chest pain patients at the emergency department (ED). Quicker and more solid decisions may be taken in these patients with application of this score. An analysis of medical consumption of 122 acute chest pain patients admitted before the introduction of this score may be indicative of possible savings.Numbers (...) of cardiology investigations and clinical admission days were counted. Charged cost of medicine was divided into three categories: ED, in-hospital, and outpatient clinic.The total cost of care was 469,631, with an average of 3849 per patient. Seventy-five percent of this cost was due to hospitalisation under the initial working diagnosis of acute coronary syndrome (ACS). This diagnosis was confirmed in only 29/122 (24 %) of the patients. The low-risk group (41 patients with HEART scores 0-3

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2012 Netherlands Heart Journal

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