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Myocardial Infarction Stabilization

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303. 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)

of thrombosis. It is used in patients without verified vascular disease and to reduce the risk of vascular events in patients at high risk or those with a history of myocardial infarction or stroke. Aspirin irreversibly inhibits cyclooxygenase (COX)-1, resulting in reduced thromboxane A2 production, which subsequently decreases platelet aggregation and activation. Aspirin has a mild antiplatelet effect, acts within 15–30 minutes, and is rapidly metabolized into its nonactive metabolite. The lifespan (...) P2Y12 inhibitor that has a rapid onset of action with a short half-life of 3–6 minutes. It is used in acute coronary care for the prevention of periprocedural myocardial infarction or stent thrombosis, with patients being transitioned to an oral thienopyridine agent postprocedurally. Cangrelor can also be used as a “bridge” therapy option for patients receiving oral thienopyridines before surgery ( x 38 Angiolillo, D.J., Firstenberg, M.S., Price, M.J , and BRIDGE Investigators. Bridging antiplatelet

2019 Society of Interventional Radiology PubMed abstract

304. 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)

) ( x 13 Lane, D.A. and Lip, G.Y. Use of the CHADS-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation . 2012 ; 126 : 860–865 ) (13) . The acryonm represents underlying cardiovascular risk factors used to calculate the score: congestive hear failiure (C), hypertension (H), age (A), diabetes (D), stroke/transient ischemic attack (S), and vascular diseases (VASc) such as peripheral arterial disease, previous myocardial infarction (...) 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 PubMed abstract

305. Telehealth for Acute and Chronic Care Consultations

department; EMS = emergency medical services; KQ = Key Question; RR = risk ratio; STEMI = ST-elevation myocardial infarction; tPA = tissue plasminogen activator; Outpatient Telehealth Consultations • Clinical outcomes: Clinical outcomes were reported in just over one-quarter of the studies of telehealth consultations and in 7 of 11 clinical topics. In three topics, there is moderate strength of evidence of the benefits of telehealth (better healing in wound care, higher response to treatment

2019 Effective Health Care Program (AHRQ)

307. Treatment of Diabetes in Older Adults (Full text)

the next 3 decades; as the population ages, the numbers of higher-risk minority groups increase, and people with diabetes live longer because of decreasing rates of cardiovascular deaths ( ). Moreover, older adults are susceptible to all of the usual complications of diabetes [reviewed in Refs. ( ) and ( )]. The prevalence rates of end-stage renal disease, loss of vision, myocardial infarction, stroke, peripheral vascular disease, and peripheral neuropathy are increased by the presence of diabetes (...) identified 23 randomized trials. For primary prevention, statins reduced the risk of coronary artery disease and myocardial infarction, but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality, cardiovascular mortality, coronary artery disease, myocardial infarction, and revascularization

2019 The Endocrine Society PubMed abstract

308. SCAI clinical expert consensus statement on the classification of cardiogenic shock (Full text)

THE CLASSIFICATION SCHEMA There are five stages of shock labeled A‐E in our proposed schema (Table , Figure ). Table 1. Descriptors of shock stages: physical exam, biochemical markers and hemodynamics Stage Description Physical exam/bedside findings Biochemical markers Hemodynamics A At risk A patient who is not currently experiencing signs or symptoms of CS, but is at risk for its development. These patients may include those with large acute myocardial infarction or prior infarction acute and/or acute (...) or diastolic heart failure may fall into this classification which is quite broad. In general, anterior wall and large distribution infarcts carry a higher risk of cardiogenic shock but some patients may manifest shock with smaller infarcts in the setting of pre‐existing left ventricular dysfunction. A recent study notes the increasing incidence of shock in the ICU without myocardial infarction. Stage B: “Beginning” CS (Pre‐shock/compensated shock) describes a patient who has clinical evidence of relative

2019 Society for Cardiovascular Angiography and Interventions PubMed abstract

309. SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: (Full text)

$9,669 248 (with MCC) $19,382 249 (w/o MCC) $12,158 92937 Bypass graft PCI (drug‐eluting stent) 10.95 17.24 5193 $9,669 246 (with MCC) $19,787 247 (w/o MCC) $12,690 92941 PCI for acute myocardial infarction 12.31 19.38 5194 $15,355 — — — — 92943 Chronic total occlusion PCI (bare metal stent) 12.31 19.38 5193 $9,669 248 (with MCC) $19,382 249 (w/o MCC) $12,158 92943 Chronic total occlusion PCI (drug‐eluting stent) 12.31 19.38 5194 $15,355 246 (with MCC) $19,787 247 (w/o MCC) $12,690 Abbreviations: RVU (...) ‐DRGv28 definitions manual Diagnosis code Description I2101‐I213 ST elevation myocardial infarction (STEMI) I214 Non‐ST elevation (NSTEMI) myocardial infarction (NSTEMI) I220‐I2209 Subsequent ST elevation MI (STEMI) I234 Rupture of chordae tendineae as current complication following acute MI I235 Rupture of papillary muscle as current complication following acute MI I2542 Coronary artery dissection I468‐469 Cardiac arrest I4901‐4901 Ventricular fibrillation/flutter I5021, I5023 Acute systolic heart

2019 Society for Cardiovascular Angiography and Interventions PubMed abstract

310. What is the evidence on the role of the arts in improving health and well-being? A scoping review

can be used to support regeneration programmes: inner-city housing projects incorporating the arts have 11 been found to improve the built environment, enhance social cohesion and decrease levels of violent crime, thus leading to safer places (90). The arts also provide job opportunities and support social mobility, employment and socioeconomic stability for both individuals and communities (91–95). For many of these programmes, the location of arts activities in community or bespoke arts venues

2019 WHO Health Evidence Network

311. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk (Full text)

Heart Attack (ALLHAT) trials. The recommendation for treatment with aspirin in this population has been eliminated due to a lack of sufficient evidence for its benefit. Subsequent data and a systematic review identified a relative risk (RR) reduction in nonfatal myocardial infarction (MI) but not in cardiovascular or all-cause mortality. The effects were modest and could be potentially outweighed by the risk of bleeding and other complications ( ). Dietary and exercise recommendations have been

2019 The Endocrine Society PubMed abstract

312. Heart Disease and Stroke Statistics (Full text)

after myocardial infarction (MI), lower risk of atrial fibrillation, and greater positive psychological functioning (dispositional optimism). Among children, from 1999 to 2000 to 2015 to 2016, prevalence of nonsmoking, ideal total cholesterol, and ideal BP improved. For example, nonsmoking among children aged 12 to 19 years went from 76% to 94%. However, meeting ideal levels for physical activity, body mass index (BMI), and blood glucose did not improve. For example, prevalence of ideal BMI declined

2019 American Heart Association PubMed abstract

313. Atrial Fibrillation (Focused Update)

or thromboembolism (doubled), vascular disease, age 65 to 74 years, sex category CI confidence interval CKD chronic kidney disease CMS U.S. Centers for Medicare & Medicaid Services CrCl creatinine clearance DAPT dual-antiplatelet therapy FDA U.S. Food and Drug Administration HF heart failure HFrEF heart failure with reduced left ventricular ejection fraction HR hazard ratio INR international normalized ratio LAA left atrial appendage LV left ventricular MI myocardial infarction NOAC non–vitamin K oral (...) anticoagulant PCI percutaneous coronary intervention RCT randomized controlled trial MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al. 2019 Focused Update on Atrial Fibrillation Page 10 TIMI Thrombolysis in Myocardial Infarction MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT January CT, et al. 2019 Focused Update on Atrial Fibrillation Page 11 4. Prevention of Thromboembolism 4.1. Risk-Based Anticoagulant Therapy (Modified From Section 4.1., “Risk- Based Antithrombotic Therapy,” in the 2014 AF Guideline

2019 American College of Cardiology

314. Vascular imaging

, and hypoxia. Furthermore, incidence of the condition is rare relative to mimics like pneumonia, pleurisy, pericarditis, and myocardial infarction. Vascular imaging plays an important role in establishing the diagnosis of pulmonary embolism, but there is evidence that vascular imaging is overutilized in select patient populations where diagnostic yield can be less than 3%. 18-23 LOW PRE-TEST PROBABILITY OF PULMONARY EMBOLISM Consensus exists among multiple high-quality evidence-based guidelines that CTA (...) to visualize metallic stent struts. Following endovascular repair, imaging is appropriate at 1 month, 6 months, 12 months, and annually thereafter for aneurysm. Annual evaluation is appropriate following endovascular repair of aortic dissection. Following surgical repair, less-frequent imaging may be performed after 1 year of stability has been established. Atheromatous disease (Adult only) Advanced imaging is considered medically necessary for evaluation of the thoracic aorta as a source of distal emboli

2019 AIM Specialty Health

315. Acute Mental Status Change, Delirium, and New Onset Psychosis

onset that make evaluation challenging, some of which are life threatening. These may be related to systemic disease, such as sepsis or infection, hypoxia, metabolic derangements, hypoglycemia, hyperglycemia, hyponatremia, hypoxia, hypothermia, acute myocardial infarction, neurologic disease including stroke, ICH, Wernicke encephalopathy (thiamine deficiency), central nervous system infection, seizure, surgery, trauma, drugs such as anticholinergic drugs, sedatives, narcotics, drug or alcohol (...) imaging. Procedure Appropriateness Category Relative Radiation Level CT head without IV contrast Usually Appropriate ??? MRI head without IV contrast Usually Appropriate O MRI head without and with IV contrast May Be Appropriate O CT head without and with IV contrast May Be Appropriate ??? CT head with IV contrast Usually Not Appropriate ??? Variant 2: Acute or progressively worsening mental status change in patient with a known intracranial process (mass, recent hemorrhage, recent infarct, central

2019 American College of Radiology

316. Cardiovascular Risk Reduction in Patients with Type 2 Diabetes and Atherosclerotic Cardiovascular Disease

of an acute coronary syndrome or myocardial infarction, stable or unstable angina, coronary heart dis- ease with or without revascularization, other arterial revascularization, stroke, or peripheral artery disease assumedtobeatheroscleroticinorigin.Anumberoftrials included a minority of patients without clinical ASCVD but required a high burden of risk factors in those patients. MACE: In the context of this document, this is either a “3-point MACE” composite of nonfatal myocardial infarction (MI (...) –0.57) 0.66 (0.25–1.74) 0.57 (0.49–0.66) 0.51 (0.37–0.70) HF hospitalization 0.61 (0.51–0.73) 0.70 (0.54–0.92) 0.57 (0.45–0.73) 0.64 (0.50–0.82) *The speci?cde?nitions of established cardiovasculardisease vary by studybut generallyinclude a historyof myocardial infarction,unstable angina, stroke, transientischemic attack, coronary revascularization, heart failure, or peripheral artery disease. A1C ¼ hemoglobin A1C; CI ¼ con?dence interval; CV ¼ cardiovascular; CVD-REAL ¼ Comparative Effectiveness

2019 American College of Cardiology

317. Tobacco Cessation Treatment

CVD deaths are attributable to cigarette smoking (5). Tobacco smoking adversely affectsallphasesoftheatherothromboticdiseaseprocess, including endothelial dysfunction (6),plaquedevelop- ment and destabilization (7), and imbalances of antith- rombotic and prothrombotic factors (8,9), culminating in acute cardiovascular (CV) events (10,11). Clinically, tobacco smoking increases the risk of coronary heart disease (CHD) (including myocardial infarction [MI] and sudden death), cerebrovascular disease (...) of stop- ping smoking (e.g., ?nancial savings, health bene?ts, behavioral control, setting an example for others), rather than focusing solely on the harms of continued smoking. For smokers who are post–myocardial infarction, the clinician can emphasize the rapid reduction in the chance of future CV morbidity and mortality by saying, for example, “Quitting smoking now is the best way for you to avoid another heart attack.” After percutaneous coronary intervention, coronary artery bypass grafting

2019 American College of Cardiology

318. Chest Pain – Possible Acute Coronary Syndrome

. The principal limitations to this technique are equipment availability and the high level of expertise required of technologists and interpreting physicians. Access to the patient may be more difficult in the magnetic environment if the patient’s stability should deteriorate. However, cardiac MRI with delayed postcontrast imaging and edema-weighted imaging provides definitive assessment of the size, distribution, and transmural extent of acute or remote myocardial infarction. Cine MRI has utility (...) syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA) [1]. Being able to establish the diagnosis rapidly and accurately may be lifesaving. The immediate cardiac workup consists of an electrocardiogram (ECG) and cardiac biomarkers. In the acute setting, even if there are no ischemic changes on ECG, a cardiac workup is often indicated. Because research has demonstrated that patients having a STEMI have improved outcomes if percutaneous

2019 American College of Radiology

319. Type 2 Diabetes Mellitus and Heart Failure (Full text)

duration of HF, diuretic therapy, and higher New York Heart Association functional class. , , , Pathophysiology of DM and HF DM can contribute to the development of structural heart disease and HF via systemic, myocardial, and cellular mechanisms. A recent state-of-the art review provides a detailed account of the underlying mechanisms of DM-associated HF. DM commonly causes structural heart disease and HF via myocardial ischemia/infarction. Hyperglycemia and hyperinsulinemia accelerate atherosclerosis (...) neuropathy). Although intensive glycemic control does not appear to reduce the risk of all-cause mortality, cardiovascular mortality, or stroke, it may reduce the risk of nonfatal myocardial infarction (MI). Although hyperglycemia with or without DM is associated with increased risk of developing HF, , available data suggest that intensive glycemic control in patients with established DM does not reduce the risk. The UKPDS (UK Prospective Diabetes Study), ADVANCE (Action in Diabetes and Vascular Disease

2019 American Heart Association PubMed abstract

320. Implementation of Supervised Exercise Therapy for Patients With Symptomatic Peripheral Artery Disease: A Science Advisory From the American Heart Association (Full text)

exercise is not feasible, the alternative exercise methods described below should be considered. outlines conditions that may occur during SET that should interrupt SET and prompt a referral back to the patient’s clinician or another responsible healthcare provider. Table 3. An Exercise Test Is Indicated for the Following Underlying Cardiac Conditions Myocardial infarction in the past 12 mo History of stable angina pectoris Heart failure Prior coronary artery bypass surgery Prior coronary angioplasty (...) or coronary stent Prior heart valve repair or replacement Heart or heart-lung transplantation Table 4. Adverse Events Requiring Medical Evaluation and SET Interruption New, progressive, or rest angina (unstable angina) New, progressive, or rest dyspnea Hemodynamic instability during exercise Acute myocardial infarction Transient ischemic attack or acute stroke New or uncontrolled cardiac arrhythmia Ischemic limb pain at rest Acral (toe, foot) ulceration or gangrene SET indicates supervised exercise

2019 American Heart Association PubMed abstract

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