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Coronary Risk Stratification of Chest Pain

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141. 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

142. 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

143. Cardiac Imaging in Low-Risk and Asymptomatic Patients

. The health technology assessment by the Agency for Healthcare Research and Quality (AHRQ) 1 examined the gold standard tests for the diagnosis of coronary artery disease (CAD) and/or acute coronary syndrome (ACS) (with or without chest pain) in patients at low to intermediate risk. AHRQ reported that among low-risk patients who are not referred for coronary angiography but who undergo clinical observation and non-invasive testing, several noninvasive tests have served as acceptable reference standards (...) review of guidelines on imaging of asymptomatic CAD 3 reported that the guidelines contained conflicting recommendations. Cardiac Imaging in Low Risk Patients 3 The identified non-randomized study 4 on cardiovascular risk stratification in asymptomatic diabetic patients without overt CAD evaluated coronary flow reserve (CFR) assessed by noninvasive transthoracic Doppler echocardiography as a predictor of prognosis. The authors reported that the CFR obtained with this test provided independent

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

144. 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

145. 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

146. 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

147. Chest Pain

, Precordial Pain From Related Chapters II. Risk Factors See s See III. Epidemiology Acute and Chest Pain are the two most commonly litigated ED claims IV. Precautions No single finding is absolutely pathognomonic nor completely reassuring in Chest Pain presentation Risk stratification, evaluation and management is based on an overall analysis of all clinical data Approach should be based on combination of factors Exam, ekg and s Consider atypical presentations of coronary syndromes in atypical patients (...) Chest Pain Chest Pain 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 Administration 4 Chest Pain Chest Pain Aka: Chest Pain , Chest Pain Causes

2015 FP Notebook

148. B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina. (PubMed)

B-type natriuretic peptide and high sensitive C-reactive protein predict 2-year all cause mortality in chest pain patients: a prospective observational study from Salta, Argentina. Several mechanisms are involved in the pathophysiology of the Acute Coronary Syndrome (ACS). We have addressed whether B-type natriuretic peptide (BNP) and high-sensitive C-reactive protein (hsCRP) in admission samples may improve risk stratification in chest pain patients with suspected ACS.We included 982 patients (...) consecutively admitted with chest pain and suspected ACS at nine hospitals in Salta, Northern Argentina. Total and cardiac mortality were recorded during a 2-year follow up period. Patients were divided into quartiles according to BNP and hsCRP levels, respectively, and inter quartile differences in mortality were statistically evaluated applying univariate and multivariate analyses.119 patients died, and the BNP and hsCRP levels were significantly higher among these patients than in survivors

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2011 BMC Cardiovascular Disorders

149. 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

150. 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

151. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update

and logistic EuroSCORE are the most commonly used. Although both are accurate in low-risk patients, accuracy is less in higher-risk subsets. These 2 scores include different covariates. The logistic EuroSCORE is based on 12 covariates derived from 14,799 patients undergoing all types of cardiac operations (mostly coronary bypass) in 8 European countries in 1995. On the other hand, the STS risk predictor is based on 24 covariates derived from 67,292 patients undergoing isolated AVR only in the United States (...) . Alternatives to AVR 3.2.1. Medical Therapy There are no proven medical treatments to prevent or delay the disease process in the aortic valve leaflets. However, evaluation and modification of cardiac risk factors is important in patients with aortic valve disease to prevent concurrent coronary artery disease (CAD). The association of AS with risk factors similar to those associated with atherosclerosis (5,6) had suggested that intervention may be possible to slow or prevent disease progression in the valve

2012 Society for Cardiovascular Angiography and Interventions

152. Diagnostic value of coronary artery calcium scoring in low-intermediate risk patients evaluated in the emergency department for acute coronary syndrome. (PubMed)

Diagnostic value of coronary artery calcium scoring in low-intermediate risk patients evaluated in the emergency department for acute coronary syndrome. Early and accurate triage of patients with possible ischemic chest pain remains challenging in the emergency department because current risk stratification techniques have significant cost and limited availability. The aim of this study was to determine the diagnostic value of the coronary artery calcium score (CACS) for the detection (...) of obstructive coronary artery disease (CAD) in low- to intermediate-risk patients evaluated in the emergency department for suspected acute coronary syndromes. A total of 225 patients presenting to the emergency department with acute chest pain and Thrombolysis In Myocardial Infarction (TIMI) scores <4 who underwent non-contrast- and contrast-enhanced coronary computed tomographic angiography were included. CACS was calculated from the noncontrast scan using the Agatston method. The prevalence

2011 American Journal of Cardiology

153. Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome (PubMed)

studies have investigated more sensitive and specific imaging modalities that can be used. Diastolic dysfunction occurs early following coronary artery occlusion and its detection is useful in confirming the diagnosis, risk stratification, and prognosis post-ACS. Cardiac magnetic resonance provides a single imaging modality for comprehensive evaluation of chest pain in the acute setting. In particular, cardiac magnetic resonance has many imaging techniques that assess diastolic dysfunction post (...) Cardiac magnetic resonance assessment of diastolic dysfunction in acute coronary syndrome Chest pain is an important presenting symptom. However, few cases of chest pain are diagnosed as acute coronary syndrome (ACS) in the acute setting. This results in frequent inappropriate discharge and major delay in treatment for patients with underlying ACS. The conventional methods of assessing ACS, which include electrocardiography and serological markers of infarct, can take time to manifest. Recent

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2017 The Journal of international medical research

154. The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease (PubMed)

The Updated NICE Guidelines: Cardiac CT as the First-Line Test for Coronary Artery Disease Cost-effective care pathways are integral to delivering sustainable healthcare programmes. Due to the overestimation of coronary artery disease using traditional risk tables, non-invasive testing has been utilised to improve risk stratification and initiate appropriate management to reduce the dependence on invasive investigations. In line with recent technological improvements, cardiac CT is a modality (...) that offers a detailed anatomical assessment of coronary artery disease comparable to invasive coronary angiography.The recent publication of the National Institute for Health and Care Excellences (NICE) Clinical Guideline 95 update assesses the performance and cost utility of different non-invasive imaging strategies in patients presenting with suspected anginal chest pain. The low cost and high sensitivity of cardiac CT makes it the non-invasive test of choice in the evaluation of stable angina

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2017 Current cardiovascular imaging reports

155. Acute Coronary Syndrome Screening and Diagnostic Practice Variation. (PubMed)

) variation in the use of noninvasive testing (NIVT) to identify obstructive coronary artery disease or detect inducible ischemia.We found that 85% of EDs utilize a formal triage protocol to screen patients for an early ECG to diagnose STEMI. Of these, 17% use chest pain as the sole criteria. For the diagnosis of NSTEMI, 58% use intervals ≥4 hours for a second troponin and 34% routinely risk stratify before troponin testing. For the diagnosis of noninfarction ischemia, the median percentage of patients (...) epidemiology study with the ED as the unit of analysis characterizing variability in the ACS evaluation across 62 diverse EDs. We explored three domains of screening and diagnostic practice: 1) variability in criteria used by EDs to identify patients for an early electrocardiogram (ECG) to diagnose ST-elevation myocardial infarction (STEMI), 2) nonuniform troponin biomarker and formalized pre-troponin risk stratification use for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI), and 3

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2017 Academic Emergency Medicine

156. CORonary MICrovascular Angina (CorMicA)

. FDA-regulated Drug Product: No Studies a U.S. FDA-regulated Device Product: No Additional relevant MeSH terms: Layout table for MeSH terms Angina Pectoris Coronary Disease Coronary Artery Disease Angina, Stable Coronary Vasospasm Myocardial Ischemia Heart Diseases Cardiovascular Diseases Vascular Diseases Chest Pain Pain Neurologic Manifestations Signs and Symptoms Arteriosclerosis Arterial Occlusive Diseases (...) Waiting Times Centre Board Study Details Study Description Go to Brief Summary: Angina is form of chest pain that is due to a lack of blood to the heart muscle. Angina is commonly triggered by stress and exertion, and is a common health problem worldwide. The diagnosis and treatment of angina is usually focused on detection of blockages in heart arteries, and relief of this problem with drugs, stents or bypass surgery. However, about one third of all invasive angiograms that are performed in patients

2017 Clinical Trials

157. A2 AR as a Novel Biomarkers for Physician Decision-making Improvement Evaluation's Patients With Suspected Acute Coronary Syndrome But Negative Troponin.

. It would be a powerful tool for risk stratification of patients presenting with chest pain but unremarkable ECG and blood tests. the investigateors therefore designed a blind multicentrique prospective study to evaluate expression and functionnaly activity of A2AR in the management of undifferentiated chest pain The objective of the study was to evaluate diagnostic accuracy between this novel biomarkers A2AR and invasive and non -invasive evaluation of patients with suspected coronary artery disease (...) patients with biomarker testing at presentation to facilitate the clinically-appropriate rapid discharge from the emergency department of patients who present with low-intermediate risk chest pain, and conversely to triage appropriate Non sustained ST elevation acute coronary syndrome (NSTE-ACS) patients to Cardiology beds, stress and non-invasive imaging modalities. Biomarkers such as high-sensitivity troponin (hs-cTn), heart-type fatty acid-binding protein (H-FABP), CRP, brain natriuretic peptide

2017 Clinical Trials

158. Diagnostic Accuracy of a New High-Sensitivity Troponin I Assay and Five Accelerated Diagnostic Pathways for Ruling Out Acute Myocardial Infarction and Acute Coronary Syndrome. (PubMed)

and acute coronary syndrome, using the Beckman's Access high-sensitivity troponin I assay with the new Vancouver Chest Pain Rule or No Objective Testing Rule enabled approximately one third of patients to be safely discharged after 2-hour risk stratification with no further testing. The EDACS, m-ADAPT, or HEART pathway enabled half of ED patients to be rapidly referred for objective testing.Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. (...) ) in Australia. Patients were classified as being at low risk according to 5 rules: modified accelerated diagnostic protocol to assess patients with chest pain symptoms using troponin as the only biomarker (m-ADAPT), the Emergency Department Assessment of Chest Pain Score (EDACS) pathway, the History, ECG, Age, Risk Factors, and Troponin (HEART) pathway, the No Objective Testing Rule, and the new Vancouver Chest Pain Rule. Endpoints were 30-day acute myocardial infarction and acute coronary syndrome

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2017 Annals of Emergency Medicine

159. Social Determinants of Risk and Outcomes for Cardiovascular Disease

early-life SEP to CVD. The Mechanisms Mediating the Relationship Between Societal Conditions and CVD section provides a detailed discussion. SEP and CVD Risk Prediction Given the substantial evidence linking SEP and CVD and findings that suggest that the Framingham risk score overestimates the risk of coronary heart disease in high-SEP individuals and underestimates the risk in low–socioeconomic status individuals, recent studies have begun to evaluate the potential benefit of including SEP in risk (...) clinicians’ decisions about their patients’ medical treatment, with incorrect, often stereotypical assumptions leading to lower-quality care for minority than for white patients. A study by Schulman and colleagues used scripted videotaped interviews of actors portraying patients with chest pain, finding that physicians were less likely to recommend catheterization for black women than for white men reporting the same symptoms. The authors found no difference in the rate of physician-recommended

2015 American Heart Association

160. Examining Renal Impairment as a Risk Factor for Acute Coronary Syndrome: A Prospective Observational Study. (PubMed)

after controlling for age, sex, hypertension, dyslipidemia, family history of cardiac disease, diabetes, patient history of cardiac disease, cardiac troponin level, and ECG findings.There is an independent association between eGFR and acute coronary syndrome risk in patients presenting to the ED with chest pain; this association is independent of age, traditional cardiac risk factors, medical history, troponin level, and ECG findings. Reduced eGFR should be considered an acute coronary syndrome risk (...) Examining Renal Impairment as a Risk Factor for Acute Coronary Syndrome: A Prospective Observational Study. This study seeks to examine whether the finding of an abnormal estimated glomerular filtration rate (eGFR) in the emergency department (ED) was associated with acute coronary syndrome in the population of patients presenting for investigation of chest pain.We used prospectively collected data on adult patients presenting with suspected acute coronary syndrome to 2 EDs in Australia and New

2013 Annals of Emergency Medicine

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