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Coronary Risk Stratification of Chest Pain


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161. Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test. (Abstract)

Diagnostic yield of coronary angiography in patients with acute chest pain: role of noninvasive test. This study investigated the diagnostic yield of invasive coronary angiography (CAG) and the impact of noninvasive test (NIV) in patients presented to emergency department (ED) with acute chest pain.Patients 50 years or older who visited ED with acute chest pain and underwent CAG were identified retrospectively. Those with ischemic electrocardiogram, elevated cardiac enzyme, known coronary (...) = .026] for detection of CAD; 45.0% vs 50.5% [P = .285] for revascularization). Positive results of NIV were significantly associated with the presence of CAD and the need for revascularization, when compared with patients without NIV or patients with negative results (P < .001, respectively).The diagnostic yield of CAG was only 65% in low- to intermediate-risk ED patients with acute chest pain. Performing of NIV provided only modest improvement in diagnostic yield of CAG. The unexpectedly low

2013 American Journal of Emergency Medicine

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

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

2013 Emergency medicine Australasia

163. Increased urinary IgM excretion in patients with chest pain due to coronary artery disease. Full Text available with Trip Pro

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

2013 BMC Cardiovascular Disorders

164. 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

165. Pulmonary embolism

: Carry out an assessment of their general medical history, a physical examination, and, where necessary, investigations (such as a chest X-ray or electrocardiogram [ECG]) to: Exclude , including other respiratory conditions (such as pneumothorax and pneumonia) and cardiac causes (such as acute coronary syndrome and acute congestive heart failure). Assess for (such as pregnancy and immobilization). Do not delay for results of a chest X-ray or ECG. Abnormalities on chest X-ray or ECG are not specific (...) coronary syndrome. Acute congestive heart failure. Dissecting or rupturing aortic aneurysm. Unstable angina. For more information, see the CKS topic on . Myocardial infarction. For more information, see the CKS topic on . Pericarditis. Musculoskeletal chest pain. Note that chest pain with chest wall palpation occurs in up to 20% of people with confirmed PE. Gastro-oesophageal reflux disease. For more information, see the CKS topic on . Any cause for collapse, such as: Vasovagal syncope. Orthostatic

2019 NICE Clinical Knowledge Summaries

166. 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 (...) the largest group presenting to the ED with chest pain (dashed arrow). *Elevated cardiac biomarker (e.g., troponin), Section 3.4. ACS indicates acute coronary syndrome; CPG, clinical practice guideline; Dx, diagnosis; ECG, electrocardiogram; ED, emergency department; MI, myocardial infarction; NQMI, non–Q-wave myocardial infarction; NSTE-ACS, non–ST- elevation acute coronary syndromes; NSTEMI, non–ST-elevation myocardial infarction; QwMI, Q-wave myocardial infarction; STEMI, ST-elevation myocardial

2014 Society for Cardiovascular Angiography and Interventions

167. 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 Full Text available with Trip Pro

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 (...) Subcommittee of the Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; and Council on Quality of Care and Outcomes Research. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation . 2017 ; 135 : e604–e633 ) (8) . Thus, it is imperative that interventional radiologists understand

2019 Society of Interventional Radiology

168. 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. Full Text available with Trip Pro

on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J . 2014 ; 35 : 2541–2619 ) (20) , particularly for patients who have had acute coronary syndrome or those with cardiac stents, especially if the stent implantation or cardiac event occurred within 1 year. Assessment of Patient Bleeding (...) 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

2019 Society of Interventional Radiology

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

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 (...) 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

2019 Clinical Correlations

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

and risk of breast cancer 393 Table D.53 Diet—processed meat and risk of breast cancer 395 Table D.54 Diet—red meat and risk of breast cancer 398 Table D.55 Environmental tobacco smoke and risk of breast cancer 401 Table D.56 Tobacco smoking and risk of breast cancer 405 Table D.57 Physical activity and risk of breast cancer 409 Table D.58 Shift work disrupting circadian rhythm and risk of breast cancer 415 Table D.59 Aspirin and risk of breast cancer 420 Table D.60 Cardiac glycosides and risk (...) 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 © Cancer Australia 2018. ISBN Print: 978–1–74127–336–6 ISBN Online: 978–1–74127–337–3 Recommended

2018 Cancer Australia

171. Breast Cancer: Medication Use to Reduce Risk

of deep vein thrombosis, pulmonary embolism, coronary heart disease (CHD) events, or stroke. When compared with placebo, raloxifene was associated with 7 more cases of VTE (RR, 1.56 [95% CI, 1.11-2.60]). Vasomotor symptoms were also increased with raloxifene use. No significant differences were found with raloxifene use on rates of CHD events, stroke, endometrial cancer, or cataracts. Based on the STAR trial, more harms were reported with tamoxifen compared with raloxifene: 4 more cases of VTE (95% CI (...) for endometrial cancer in women with a uterus. Tamoxifen also increases risk of cataracts. Vasomotor symptoms (hot flashes) are a common adverse effect of both medications. The USPSTF found adequate evidence that the harms of aromatase inhibitors are also small to moderate. These harms include vasomotor symptoms, gastrointestinal symptoms, musculoskeletal pain, and possible cardiovascular events, such as stroke. Aromatase inhibitors do not reduce, and may even increase, risk of fractures. USPSTF Assessment

2019 U.S. Preventive Services Task Force

172. BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing

with BRCA1/2 mutations, discussion of these types of cancer is outside the scope of this recommendation. Accuracy of Familial Risk Assessment The USPSTF reviewed studies of familial risk stratification tools that could be used in primary care settings to determine the likelihood of potentially harmful BRCA1/2 mutations. These tools are primarily intended for use by health care clinicians untrained in genetic cancer risk assessment to guide referral to genetic counselors for more definitive evaluation (...) studies of oophorectomy or salpingo-oophorectomy reported harms associated with surgical interventions, although most were small in size and had mixed outcomes. For mastectomy, complication rates ranged from 49% to 69%. Complications included numbness, pain, tingling, infection, swelling, breast hardness, bleeding, organizing hematoma, failed reconstruction, breathing problems, thrombosis, and pulmonary embolism. Postsurgical complications associated with oophorectomy/salpingo-oophorectomy included

2019 U.S. Preventive Services Task Force

173. A 37 year old woman with Chest Pain

. who had a sudden onset of central chest pain with hyperacute t waves in multiple leads. ECG then switched to normal. A week later we had dramatic t wave inversion in just the leads where those very tall t waves were seen. So we guessed unstable angina. Cardiac enzymes turned out normal. Coronary angiogram was done - normal. Nevertheless patient died a few weeks later at home. What it was? - no idea. Do you guys have a guess/idea? Angiogram can miss such ischemia due to: 1) spasm 2) non-stenotic (...) hour is lost which greatly worsens a patient's prognosis. Furthermore if one is seeing a patient with chest pain it is thought that the pain is "non-cardiac" then a diagnosis should be sought as there are numerous other life-threatening causes of chest pain which should be ruled out .. such as an aortic aneurism or pulmonary embolism. Thank you for the case. Its sad for the patient but the lesson is to learn to recognise these infarct patterns so that they aren't missed in the future. Regards

2016 Dr Smith's ECG Blog

174. Acute coronary syndrome

/American College of Cardiology guidelines recommend that clinical risk factors should be considered together when assessing the likelihood of myocardial ischaemia relating to ACS. These include increasing age, sex, family history of coronary heart disease, prior history of ischaemic heart disease and peripheral vascular disease, diabetes mellitus and renal impairment. High-risk features include worsening angina, prolonged pain (>20 minutes), pulmonary oedema (Killip class =2), hypotension (...) 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

2016 SIGN

175. CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease (Abstract)

CT coronary angiography and exercise ECG in a population with chest pain and low-to-intermediate pre-test likelihood of coronary artery disease To evaluate diagnostic accuracy of exercise ECG (ex-ECG) versus 64-slice CT coronary angiography (CT-CA) for the detection of significant coronary artery stenosis in a population with low-to-intermediate pre-test likelihood of coronary artery disease (CAD).Retrospective single centre.Tertiary academic hospital.177 consecutive patients (88 men, 89 women (...) , mean age 53.5±7.6 years) with chest pain and low-to-intermediate pre-test likelihood of CAD were retrospectively enrolled.All patients underwent ex-ECG, CT-CA and invasive coronary angiography (ICA).A lumen diameter reduction of ≥50% was considered as significant stenosis for CT-CA. Ex-ECG was classified as positive, negative or non-diagnostic.were compared with ICA. Diagnostic accuracy of CT-CA and ex-ECG was calculated using ICA as the reference standard. A parallel comparative analysis using

2011 EvidenceUpdates

176. 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 ( (...) -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

177. Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review. (Abstract)

Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review. Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC).To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest (...) an increased risk of an acute life-threatening condition in the prehospital setting in cases of acute chest pain. These factors may form the basis for prehospital risk stratification in acute chest pain.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

2016 International journal of cardiology

178. Retrospective Study of Acute Chest Pain in Extremely Critical Condition for More Than Ten Years

, nausea etc), physical signs and lab examination in early diagnosis and risk stratification of acute chest pain in extremely critical condition. To study the effect factors of thrombus burden in STEMI patients, at the same time, creat a a simple, practical and scientific method of blood clots classification. Condition or disease Acute Myocardial Infarction Pulmonary Embolism Aortic Dissection Study Design Go to Layout table for study information Study Type : Observational Estimated Enrollment : 7000 (...) status was: Recruiting First Posted : July 19, 2016 Last Update Posted : July 25, 2016 Sponsor: Qilu Hospital of Shandong University Information provided by (Responsible Party): Qilu Hospital of Shandong University Study Details Study Description Go to Brief Summary: Acute non-traumatic chest pain is a common kind of symptom in extremely critical condition, with various pathogenesis and different level of risk . Chest pain in high risk takes 1/3 of that. It mainly includes acute coronary syndrome

2016 Clinical Trials

179. Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain. Full Text available with Trip Pro

Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain. Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain.suPAR concentrations were measured on admission in 449 consecutive chest pain patients (...) improved the predictive accuracy of abnormal ECG findings and increased troponin concentrations regarding all-cause mortality (c statistics, 0.751-0.805; P < 0.0001).suPAR is a strong predictor of adverse long-term outcomes and improves risk stratification beyond traditional risk variables in chest pain patients admitted with suspected NSTEACS.

2013 Clinical Chemistry

180. Acute and Chronic Heart Failure Full Text available with Trip Pro

to recovery BTT bridge to transplantation BUN blood urea nitrogen CABANA Catheter ABlation versus ANtiarrhythmic drug therapy for Atrial fibrillation CABG coronary artery bypass graft/grafting CAD coronary artery disease CARE-HF CArdiac REsynchronization in Heart Failure CASTLE-AF Catheter Ablation versus Standard conventional Treatment in patients with LEft ventricular dysfunction and Atrial Fibrillation CCB calcium-channel blocker CCM cardiac contractility modulation CCS Canadian Cardiovascular Society (...) anticoagulant NP natriuretic peptide NPPV non-invasive positive pressure ventilation NSAID non-steroidal anti-inflammatory drug NSTE-ACS non-ST elevation acute coronary syndrome NT-proBNP N-terminal pro-B type natriuretic peptide NYHA New York Heart Association o.d. omne in die (once daily) OMT optimal medical therapy OSA obstructive sleep apnoea PaCO 2 partial pressure of carbon dioxide in arterial blood PAH pulmonary arterial hypertension PaO 2 partial pressure of oxygen in arterial blood PARADIGM-HF

2016 European Society of Cardiology

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