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Low risk ACS

Anne-Maree Kelly, Sharon Klim
BACKGROUND: To determine the rate of all cause and cardiac death, new myocardial infarction (MI) or coronary revascularisation at over three years from index visit in emergency department chest pain patients without known coronary artery disease (CAD) at index presentation who had a negative electrocardiogram (ECG) and biomarker workup for acute coronary syndrome (ACS). METHODS: An unplanned sub-study of a prospective observational study of consecutive adult patients presenting to the ED with atraumatic chest pain (or equivalents)...
September 13, 2016: Heart, Lung & Circulation
Phillip M Mitchell, Benjamin M Weisenthal, Cory A Collinge
OBJECTIVE: To evaluate the incidence of knee sepsis following suprapatellar nailing of open tibia fractures. DESIGN: Retrospective SETTING:: ACS Level 1 trauma centerPatients/Participants: We reviewed 139 open tibia fractures that underwent suprapatellar nailing as definitive treatment over a five-year period (January 1, 2011 to January 1, 2016). The majority of patients (90%, n=126) underwent intramedullary nailing at the time of their initial surgery. We defined knee sepsis as intra-articular infection requiring operative debridement, either open or arthroscopically, within one month's time...
October 1, 2016: Journal of Orthopaedic Trauma
Rachel S Bronheim, Eric K Oermann, Samuel K Cho, John M Caridi
STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To identify associations between abnormal coagulation profile and postoperative morbidity and mortality in patients undergoing posterior lumbar fusion (PLF). SUMMARY OF BACKGROUND DATA: The literature suggests that abnormal coagulation profile is associated with postoperative complications, notably the need for blood transfusion. However, there is little research that directly addresses the influence of coagulation profile on postoperative complications following PLF...
October 17, 2016: Spine
Gian Marco Rosa, Daniele Bianco, Alberto Valbusa, Laura Massobrio, Francesco Chiarella, Claudio Brunelli
After acute coronary syndromes (ACS), the so-called dual antiplatelet therapy (DAPT), which usually consists of low-dose of aspirin in combination with a thienopyridine (clopidogrel, prasugrel) or with a cyclopentyltriazolopyrimidine (ticagrelor), reduces the risk of ischemic events. Ticagrelor, un particular, is an effective drug as it isn' a prodrug, doesn't require metabolic activation and demonstrates a rapid onset and faster offset of action. Areas covered: This article evaluates the pharmacokinetics, efficacy, safety and tolerability of ticagrelor during DAPT after ACS and its potential use beyond the canonical twelve months after PCI...
October 7, 2016: Expert Opinion on Drug Metabolism & Toxicology
Brit Long, Alex Koyfman
BACKGROUND: Chest pain is a common presentation to the emergency department (ED), though the majority of patients are not diagnosed with acute coronary syndrome (ACS). Many patients are admitted to the hospital due to fear of ACS. OBJECTIVE: Our aim was to investigate controversies in low-risk chest pain evaluation, including risk of missed ACS, stress test, and coronary computed tomography angiography (CCTA). DISCUSSION: Chest pain accounts for 10 million ED visits in the United States annually...
September 29, 2016: Journal of Emergency Medicine
Ahmed Hassan, Tomotaka Dohi, Katsumi Miyauchi, Manabu Ogita, Makoto Kurano, Ryunosuke Ohkawa, Kazuhiro Nakamura, Hiroshi Tamura, Kikuo Isoda, Shinya Okazaki, Yutaka Yatomi, Hiroyuki Daida
BACKGROUND: Numerous studies have reported the relationship between elevated homocysteine (Hcy) levels and the risk of coronary artery disease. However, there is insufficient information about the effects of Hcy levels on long-term clinical outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS: In the Juntendo-registry cohort from 2003 to 2004, pre-procedural Hcy levels and Hcy thiolactonase activity (HTlase) were measured in 315 consecutive all-comer patients who underwent PCI for stable coronary artery disease or acute coronary syndrome (ACS)...
September 27, 2016: Journal of Cardiology
J Ryan Hill, Braden McKnight, William C Pannell, Nathanael Heckmann, Lakshmanan Sivasundaram, Amir Mostofi, Reza Omid, George F Rick Hatch
PURPOSE: The purpose of this study was to evaluate a large population of shoulder arthroscopy cases in order to provide insight into the risk factors associated with readmission following this common orthopaedic procedure. METHODS: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) billing codes to identify all patients older than 18 years of age who underwent shoulder arthroscopy between 2011 and 2013...
September 15, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Anthony W A Wassef, Hadi Khafaji, Ishba Syed, Andrew T Yan, Jacob A Udell, Shaun G Goodman, Asim N Cheema, Akshay Bagai
BACKGROUND: Current guidelines recommend 12 months of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation. Whether the duration of DAPT can be safely shortened with use of second-generation DESs is unclear. METHODS: We conducted a meta-analysis of randomized controlled trials comparing short duration (SD) (3-6 months) with standard longer duration (LD) (≥12 months) DAPT in patients treated with primarily second-generation DES implantation...
September 15, 2016: Journal of Invasive Cardiology
Jelena Slump, Peter C Ferguson, Jay S Wunder, Anthony Griffin, Harald J Hoekstra, Shaghayegh Bagher, Toni Zhong, Stefan O P Hofer, Anne C O'Neill
INTRODUCTION: The ACS-NSQIP surgical risk calculator is an open-access on-line tool that estimates the risk of adverse post-operative outcomes for a wide range of surgical procedures. Wide surgical resection of soft tissue sarcoma (STS) often requires complex reconstructive procedures that can be associated with relatively high rates of complications. This study evaluates the ability of this calculator to identify patients with STS at risk for post-operative complications following flap reconstruction...
October 2016: Journal of Surgical Oncology
Fernando Gondim, Ana Caribé, Karine Ferreira Vasconcelos, Alexandre Dantas Segundo, Francisco Bandeira
BACKGROUND: Vitamin D deficiency has been associated with cardiovascular risk factors, including type 2 diabetes mellitus (T2DM). Evidence shows that patients with low serum 25-hydroxyvitamin D (25OHD) concentrations have a higher risk of developing coronary artery disease. OBJECTIVE: The objective of this study was to assess vitamin D as a predictor of the severity in diabetics with acute coronary syndrome (ACS). METHODS: A total of 166 patients were diagnosed with ACS...
2016: Clinical Medicine Insights. Endocrinology and Diabetes
Isabella Canavero, Anna Cavallini, Lucia Sacchi, Silvana Quaglini, Natale Arnò, Patrizia Perrone, Maria Luisa DeLodovici, Simona Marcheselli, Giuseppe Micieli
BACKGROUND: It has been widely reported that anticoagulants (ACs) are underused for primary and secondary prevention of ischemic stroke in patients with atrial fibrillation (AFib). Furthermore, precise evidence-based guidelines about the best timing for AC initiation after acute stroke are currently lacking. METHODS AND RESULTS: In this retrospective, observational study, we analyzed prescription trends in AFib patients with acute ischemic stroke who were hospitalized in four neurologic stroke units of our region (Lombardia, Italy)...
September 7, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Siti-Zainora Mohd-Zulkefli, Marhanis-Salihah Omar, Adyani Md-Redzuan
BACKGROUND: The incidence of acute coronary syndrome (ACS), one of the most common cardiovascular diseases, is high. Lipid goal attainment is one of the important factors to reduce the risk of recurrent heart attack. Identification of factors influencing lipid goal attainment such as age, female, race, underlying comorbidities, intensity of lipid-lowering therapy, patients' knowledge, and patients' belief about medicine would be beneficial in achieving the lipid goal. This study is aimed to determine lipid profile attainment and prescribing pattern of lipid-lowering therapy as well as to identify factors influencing lipid profile attainment among ACS patients...
2016: Patient Preference and Adherence
Fathima Aaysha Cader, M Maksumul Haq, Sahela Nasrin, Md Rezaul Karim
BACKGROUND: Striking an adequate balance between bleeding risks and prevention of stent thrombosis can be challenging in the setting of percutaneous coronary intervention (PCI) with drug eluting stents (DES) in acute myocardial infarction (MI). This is more pronounced in patients treated with both low molecular weight heparin (LMWH) and dual antiplatelet therapy (DAPT). Prasugrel, a second generation thienopyridine with more potent platelet inhibition capability, is associated with significant bleeding risks...
August 30, 2016: BMC Cardiovascular Disorders
Alon Eisen, Christopher P Cannon, Michael A Blazing, Erin A Bohula, Jeong-Gun Park, Sabina A Murphy, Jennifer A White, Robert P Giugliano, Eugene Braunwald
AIMS: To examine the efficacy and safety of ezetimibe added to statin in patients with prior coronary artery bypass graft surgery (CABG) following hospitalization for an acute coronary syndrome (ACS). METHODS AND RESULTS: In the IMPROVE-IT trial, post-ACS patients with mean low density lipoprotein cholesterol (LDL-C) of 93.8 mg/dL at presentation were randomized to simvastatin/ezetimibe or simvastatin/placebo. The primary endpoint was cardiovascular death, major coronary event or stroke, and the median follow-up was 6 years...
August 28, 2016: European Heart Journal
Selçuk Yazıcı, Tuncay Kırış, Ufuk S Ceylan, Sait Terzi, Aysun Erdem, Işıl Atasoy, Ayşe Emre, Kemal Yeşilçimen
BACKGROUND: Low T3 which is defined as decreased triiodothyronine (T3) and normal thyroid-stimulating hormone (TSH) and thyroxin (T4) levels is present in many acute diseases and is related to increased mortality. We studied low T3 level's relation to long-term mortality in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. METHODS: T3, T4, and TSH levels of consecutive NSTE-ACS patients were measured. Patients with normal T4 and TSH levels, but low T3 level were defined as low T3 group...
August 27, 2016: Journal of Clinical Laboratory Analysis
Maria Dorobantu, Stefan Bogdan
With the ageing of the general population, clinicians are facing with increased frequency the challenge of administering parenteral anti-coagulation therapy in the elderly, the main indications being venous thromboembolism (VTE), acute coronary syndromes (ACS), atrial fibrillation and bridging therapy. Assessing the risk/benefit ratio is always difficult in this category of patients, because of the higher risk for hemorrhagic events, although in most cases the benefit outweighs the risk, especially in the setting of VTE...
November 1, 2016: International Journal of Cardiology
Marie-Eva Laurencet, François Girardin, Fabio Rigamonti, Anne Bevand, Philippe Meyer, David Carballo, Marco Roffi, Stéphane Noble, François Mach, Baris Gencer
INTRODUCTION: Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported. METHODS: We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points)...
2016: PloS One
R Sigurjonsdottir, S Barywani, P Albertsson, M Fu
BACKGROUND: Although the elderly comprise the majority of acute coronary syndrome (ACS) patients, limited data exist on major adverse cardiovascular events (MACEs) and quality of life (QoL). OBJECTIVES: To study MACEs and QoL prospectively in ACS patients >70years referred for coronary angiography. METHODS: A prospective observational study that included ACS patients >70years undergoing coronary angiography. The outcomes were MACEs and QoL 3years after inclusion...
November 1, 2016: International Journal of Cardiology
Massimo De Filippo, Raffaella Capasso
Acute chest pain is an important clinical challenge and a major reason for presentation to the emergency department. Although multiple imaging techniques are available to assess patients with suspected acute coronary syndrome (ACS), considerable interest has been focused on the use of non-invasive imaging options as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR). According to several recent evidences, CCTA has been shown to represent a useful tool to rapidly and accurately diagnose coronary artery disease (CAD) in patients with low to intermediate cardiovascular risk...
July 2016: Annals of Translational Medicine
Venetia Notara, Demosthenes B Panagiotakos, Yannis Kogias, Petros Stravopodis, Antonis Antonoulas, Spyros Zombolos, Yannis Mantas, Christos Pitsavos
OBJECTIVES: The association between educational status and 10-year risk for acute coronary syndrome (ACS) and all-cause mortality was evaluated. METHODS: From October 2003 to September 2004, 2172 consecutive ACS patients from six Greek hospitals were enrolled. In 2013 to 2014, a 10-year follow-up (2004-2014) assessment was performed for 1918 participants (participation rate, 88%). Each patient's educational status was classified as low (<9 years of school), intermediate (9 to 14 years), or high (>14 years)...
July 2016: Journal of Preventive Medicine and Public Health, Yebang Ŭihakhoe Chi
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