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https://www.readbyqxmd.com/read/27914806/interprovincial-differences-in-canadian-coronary-care-unit-resource-use-and-outcomes
#1
Sean van Diepen, Meng Lin, Justin A Ezekowitz, Finlay A McAlister, Douglas S Lee, Shaun G Goodman, Paul W Armstrong, Padma Kaul
International registries have reported a wide variation in coronary care unit (CCU) admission rates for patients hospitalized with acute coronary syndrome (ACS) or heart failure (HF). Little is known about variation in Canadian interprovincial use and outcomes. Canadian Institute of Health Information data were used to identify hospitalized patients admitted to a CCU with a primary diagnosis of ACS or HF between April 1, 2007 and March 31, 2013. We examined interprovincial differences in CCU admission rates, use of CCU restricted therapies in the first 2 days of admission, and the association between CCU admission rate and risk-adjusted in-hospital mortality at the provincial level...
October 19, 2016: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27914504/on-treatment-analysis-of-the-improved-reduction-of-outcomes-vytorin-efficacy-international-trial-improve-it
#2
Michael A Blazing, Robert P Giugliano, James A de Lemos, Christopher P Cannon, Andrew Tonkin, Christie M Ballantyne, Basil S Lewis, Thomas A Musliner, Andrew M Tershakovec, Yuliya Lokhnygina, Jennifer A White, Craig Reist, Amy McCagg, Eugene Braunwald
BACKGROUND: We aimed to determine the efficacy and safety of adding ezetimibe (Ez) to simvastatin (S) in a post-acute coronary syndrome (ACS) population in a prespecified on-treatment analysis. METHODS: We evaluated 17,706 post-ACS patients from the IMPROVE-IT trial who had low-density lipoprotein cholesterol values between 50 and 125 mg/dL and who received Ez 10 mg/d with S 40 mg/d (Ez/S) or placebo with simvastatin 40 mg/d (P/S). The primary composite end point was cardiovascular death, myocardial infarction, unstable angina, coronary revascularization ≥30 days postrandomization, or stroke...
December 2016: American Heart Journal
https://www.readbyqxmd.com/read/27892884/%C3%AE-blocker-dosage-and-outcomes-after-acute-coronary-syndrome
#3
Jason E Allen, Stacey Knight, Raymond O McCubrey, Tami Bair, Joseph Brent Muhlestein, Jeffrey J Goldberger, Jeffrey L Anderson
BACKGROUND: Although β-blockers increase survival in acute coronary syndrome (ACS) patients, the doses used in trials were higher than doses used in practice, and recent data do not support an advantage of higher doses. We hypothesized that rates of major adverse cardiac events (MACE), all-cause death, myocardial infarction, and stroke are equivalent for patients on low-dose and high-dose β-blocker. METHODS: Patients admitted to Intermountain Healthcare with ACS and diagnosed with ≥70% coronary stenosis between 1994 and 2013 were studied (N = 7,834)...
October 22, 2016: American Heart Journal
https://www.readbyqxmd.com/read/27885830/extended-dual-antiplatelet-therapy-after-acute-coronary-syndrome-in-spain-results-from-the-epicor-study
#4
Alfredo Bardají, Manuel Leal, Vicente Arrarte, Xavier Garcia-Moll, Leopoldo Pérez de Isla, Héctor Bueno
INTRODUCTION: Real-world, country-specific studies of dual antiplatelet therapy (DAPT) duration among survivors of acute coronary syndrome (ACS) are important for improving long-term prognosis. AIMS: To investigate DAPT duration after hospital discharge for ACS in Spain. RESULTS: Data from patients enrolled in the Spanish cohort of the EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) study (NCT01171404) were analyzed for changes to antithrombotic medication up to 2 years post-discharge according to index event diagnosis and patient characteristics...
November 25, 2016: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/27884453/a-call-for-a-standardized-definition-of-perforated-appendicitis
#5
Andrew P Rogers, Tiffany J Zens, Charles M Leys, Peter F Nichol, Daniel J Ostlie
BACKGROUND: Abscess rates have been reported to be as low as 1% and as high as 50% following perforated appendicitis (PA). This range may be because of lack of universal definition for PA. An evidence-based definition (EBD) is crucial for accurate wound classification, risk-stratification, and subsequent process optimization. ACS NSQIP-Pediatric guidelines do not specify a definition of PA. We hypothesize that reported postoperative abscess rates underrepresent true incidence, as they may include low-risk cases in final calculations...
October 27, 2016: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/27860148/a-review-of-rapid-access-cardiology-services-can-these-reduce-the-burden-of-acute-chest-pain-on-australian-and-new-zealand-health-services
#6
REVIEW
Harry Klimis, Aravinda Thiagalingam, Mikhail Altman, Emily Atkins, Gemma Figtree, Harry Lowe, N Wah Cheung, Pramesh Kovoor, A Robert Denniss, Clara K Chow
Chest pain is common and places a significant burden on hospital resources. Many patients with undifferentiated low to intermediate risk chest pain are admitted to hospital. Rapid Access Cardiology (RAC) services are hospital co-located cardiologist-led outpatient clinics that provide rapid assessment and immediate management but not long term management. This service model is described as part of chest pain management and the National Service Framework for coronary heart disease in the United Kingdom (UK)...
November 16, 2016: Internal Medicine Journal
https://www.readbyqxmd.com/read/27847338/a-chinese-patent-medicine-shexiang-baoxin-pill-for-non-st-elevation-acute-coronary-syndromes-a-systematic-review
#7
Zhou Zhou, Weixing Shen, Lili Yu, Cong Xu, Qibiao Wu
ETHNOPHARMACOLOGICAL RELEVANCE: Shexiang Baoxin Pill (SXBXP) is a well-known Chinese patent medicine, widely used for Non-ST-elevation acute coronary syndromes (NSTE-ACS). It is composed of seven materia medicas or extracts (Moschus, Radix Ginseng, Calculus Bovis, Cortex Cinnamomi, Styrax, Venenum Bufonis and Borneolum Syntheticum). AIM OF THE STUDY: This study is aimed to systematically review the relevant randomised controlled trials (RCTs) to determine the efficacy and safety of SXBXP for long-term management of NSTE-ACS...
November 12, 2016: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/27846004/implementation-of-a-risk-stratification-and-management-pathway-for-acute-chest-pain-in-the-emergency-department
#8
Christopher W Baugh, Jeffrey O Greenberg, Simon A Mahler, Joshua M Kosowsky, Jeremiah D Schuur, Siddharth Parmar, George R Ciociolo, Christina W Carr, Roya Ghazinouri, Benjamin M Scirica
OBJECTIVES: Chest pain is a common complaint in the emergency department, and a small but important minority represents an acute coronary syndrome (ACS). Variation in diagnostic workup, risk stratification, and management may result in underuse, misuse, and/or overuse of resources. METHODS: From July to October 2014, we conducted a prospective cohort study in an academic medical center by implementing a Standardized Clinical Assessment and Management Plan (SCAMP) for chest pain based on the HEART score...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27830362/numeracy-predicts-risk-of-pre-hospital-decision-delay-a-retrospective-study-of-acute-coronary-syndrome-survival
#9
Dafina Petrova, Rocio Garcia-Retamero, Andrés Catena, Edward Cokely, Ana Heredia Carrasco, Antonio Arrebola Moreno, José Antonio Ramírez Hernández
BACKGROUND: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. PURPOSE: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy...
November 9, 2016: Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine
https://www.readbyqxmd.com/read/27823684/impact-of-the-2013-american-college-of-cardiology-american-heart-association-cholesterol-guidelines-on-the-prescription-of-high-intensity-statins-in-patients-hospitalized-for-acute-coronary-syndrome-or-stroke
#10
Michael Valentino, Jad Al Danaf, Andrew Panakos, Loheetha Ragupathi, Danielle Duffy, David Whellan
BACKGROUND: The 2013 American College of Cardiology/American Heart Association cholesterol management guidelines represented a paradigm shift from the National Cholesterol Education Program Adult Treatment Panel III guidelines, replacing low-density lipoprotein cholesterol targets with a risk assessment model to guide statin therapy. Our objectives are to compare provider prescription of high-intensity statin therapy in patients hospitalized with acute coronary syndrome (ACS) or cerebrovascular accident (CVA) before and after the publication of the 2013 cholesterol guidelines, determine potential predictors of high-intensity statin utilization, and identify targets for improvement in cardiovascular risk reduction among these high-risk populations...
November 2016: American Heart Journal
https://www.readbyqxmd.com/read/27821539/endothelial-microparticles-from-acute-coronary-syndrome-patients-induce-premature-coronary-artery-endothelial-cells-ageing-and-thrombogenicity-role-of-the-ang-ii-at1-receptor-nadph-oxidase-mediated-activation-of-mapks-and-pi3-kinase-pathways
#11
Malak Abbas, Laurence Jesel, Cyril Auger, Lamia K Amoura, Nathan Messas, Guillaume Manin, Cordula Rumig, Antonio J León-González, Thais P Ribeiro, Grazielle C Silva, Raghida Abou-Merhi, Eva Hamade, Markus Hecker, Yannick Georg, Nabil Chakfe, Patrick Ohlmann, Valérie B Schini-Kerth, Florence Toti, Olivier Morel
BACKGROUND: -Microparticles (MPs) have emerged as a surrogate marker of endothelial dysfunction and cardiovascular risk. This study examined the potential of MPs from senescent endothelial cells (ECs) or from patients with acute coronary syndrome (ACS) to promote premature ECs ageing and thrombogenicity. METHODS: -Primary porcine coronary ECs were isolated from the left circumflex coronary artery. MPs were prepared from ECs and venous blood from patients with ACS (n=30) and from healthy volunteers (n=6) by sequential centrifugation...
November 7, 2016: Circulation
https://www.readbyqxmd.com/read/27821064/the-prognostic-utility-of-grace-risk-score-in-predictive-cardiovascular-event-rate-in-stemi-patients-with-successful-fibrinolysis-and-delay-intervention-in-non-pci-capable-hospital-a-retrospective-cohort-study
#12
Yotsawee Chotechuang, Arintaya Phrommintikul, Roungtiva Muenpa, Jayanton Patumanond, Tuanchai Chaichuen, Srun Kuanprasert, Noparat Thanachikun, Thanawat Benjanuwatra, Apichard Sukonthasarn
BACKGROUND: Fibrinolytic therapy is the main reperfusion therapy for most STEMI patients in several countries. Current practice guidelines recommended routine early pharmacoinvasive (within 3-24 h after successful fibrinolysis, however it cannot be performed in timely fashion due to limitation of PCI-capable hospitals. This study aimed to evaluate the prognostic utility of the GRACE score in patients receiving delayed intervention after successful fibrinolysis in non PCI-capable hospital...
November 8, 2016: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/27819783/-acute-coronary-syndromes-in-latin-america-lessons-from-the-access-registry
#13
Carlos Martínez-Sánchez, Carlos Jerjes-Sánchez, José Carlos Nicolau, Oscar Bazzino, Norka Antepara, Ricardo Mármol
BACKGROUND: Evidence of the clinical characteristics, treatment and outcomes among Latin American (LA) patients with acute coronary syndromes (ACS) is scarce. METHODS: ACCESS, international prospective multicenter registry to evaluate risk stratification, management and outcomes in ACS (unstable angina or non-ST elevation myocardial infarction [UA/NSTEMI] or ST elevation myocardial infarction [STEMI]) in developing countries. Primary endpoint: all-cause death at 1 year; all-cause mortality within 30 days was also recorded, Patients with acute ischemic symptoms within 24 hours of symptoms onset and electrocardiographic evidence of ischemia were enrolled...
November 2016: Revista Médica del Instituto Mexicano del Seguro Social
https://www.readbyqxmd.com/read/27815268/relationship-of-platelet-reactivity-with-bleeding-outcomes-during-long-term-treatment-with-dual-antiplatelet-therapy-for-medically-managed-patients-with-non-st-segment-elevation-acute-coronary-syndromes
#14
Jan H Cornel, E Magnus Ohman, Benjamin Neely, Joseph A Jakubowski, Deepak L Bhatt, Harvey D White, Diego Ardissino, Keith A A Fox, Dorairaj Prabhakaran, Paul W Armstrong, David Erlinge, Udaya S Tantry, Paul A Gurbel, Matthew T Roe
BACKGROUND: The relationship between "on-treatment" low platelet reactivity and longitudinal risks of major bleeding dual antiplatelet therapy following acute coronary syndromes remains uncertain, especially for patients who do not undergo percutaneous coronary intervention. METHODS AND RESULTS: We analyzed 2428 medically managed acute coronary syndromes patients from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial who had serial platelet reactivity measurements (P2Y12 reaction units; PRUs) and were randomized to aspirin+prasugrel versus aspirin+clopidogrel for up to 30 months...
November 4, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27814786/usefulness-of-mean-platelet-volume-to-predict-significant-coronary-artery-disease-in-patients-with-non-st-elevation-acute-coronary-syndromes
#15
Tuncay Taskesen, Harsimran Sekhon, Igor Wroblewski, Mikhail Goldfarb, Muhammad B Ahmad, Quang T Nguyen, Ibtihaj A M Fughhi, Adi Gidron, Shahriar Dadkhah
Acute coronary syndrome (ACS) is characterized by unstable plaque with thrombotic process involving central role of platelets. The diagnosis and prediction of significant coronary artery disease (CAD) in non-ST-elevation ACS (NSTE-ACS) can be challenging. The central role of platelets in acute atherothrombosis in NSTE-ACS spurred appreciable interest in the diagnostic and predictive role of platelet activity. Mean platelet volume (MPV) is one of the most promising laboratory markers in patients with CAD. This retrospective study was designed to investigate the diagnostic and predictive value of high MPV levels in patients with NSTE-ACS with significant CAD...
October 8, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27796707/comparison-of-clinical-based-and-ecg-based-triage-of-acute-chest-pain-in-the-emergency-department
#16
Melanie Dechamps, Diego Castanares-Zapatero, Patrick Vanden Berghe, Philippe Meert, Alessandro Manara
In the Emergency Department, chest pain triage systems are based on either clinical features or ECG recording. In this prospective, single-center, observational study, we aimed to compare the diagnostic performance of these triage systems in distinguishing acute coronary syndromes (ACS) from diseases of mild severity. Patients were sorted into the triage systems based on collected data at admission and on a systematic 12-lead ECG performed at triage. The final diagnosis was determined after a 30-day follow-up...
October 28, 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/27796172/risk-factors-between-intracranial-extracranial-atherosclerosis-and-anterior-posterior-circulation-stroke-in-ischaemic-stroke
#17
Yan Li, Yefeng Cai, Min Zhao, Jingbo Sun
OBJECTIVES: Atherosclerosis is an important cause of stroke and remains a challenge for stroke prevention. Risk factors involved in atherosclerotic stroke and anterior and posterior circulation strokes (ACS and PCS, respectively) are different. The purpose of this study is to investigate differences in risk factors between intracranial and extracranial atherosclerosis (ICAS and ECAS), ACS and PCS, and ICAS/ECAS with ACS/PCS in a Chinese acute ischaemic stroke population. METHODS: We analysed 551 ischaemic stroke patients who had been enrolled between August 2005 and July 2008...
October 31, 2016: Neurological Research
https://www.readbyqxmd.com/read/27788301/prasugrel-use-following-pci-and-associated-patient-outcomes-insights-from-the-national-va-cart-program
#18
Vikas Aggarwal, Ehrin J Armstrong, Wenhui Liu, Thomas M Maddox, P Michael Ho, Evan Carey, Tracy Wang, Matthew Sherwood, Thomas T Tsai, John S Rumsfeld, Steven M Bradley
BACKGROUND: Prasugrel is more effective than clopidogrel in preventing thrombotic complications after percutaneous coronary intervention (PCI) among patients with acute coronary syndromes (ACS), but it increases the risk of bleeding in subgroups of patients. There is limited data on whether prasugrel use in routine practice is targeted to clinical settings with greatest anticipated patient benefit. METHODS: In a national cohort of 11 617 veterans who underwent PCI between 2010 and 2013 at Veterans Administration hospitals nationwide, we assessed overall trends in the use of prasugrel and the frequency of prasugrel use in patients with contraindications (prior transient ischemic attack or cerebrovascular accident), higher bleeding risk (age ≥75 or weight <60 kg), and nonindicated settings (non-acute coronary syndrome [non-ACS])...
October 2016: Clinical Cardiology
https://www.readbyqxmd.com/read/27785526/efficacy-and-safety-of-aspirin-combined-with-warfarin-after-acute-coronary-syndrome-a-meta-analysis
#19
REVIEW
P Zhang, J Li, C Wu, X Huang, L Li, W Zhang, C Shen
A comprehensive meta-analysis was performed to investigate whether the combination of high-/low-dose of aspirin and various intensities of warfarin (W) offer greater benefit than aspirin (ASA) alone. A total of 14 randomized clinical trials (RCTs) having 26,916 patients with acute coronary syndrome (ACS) met inclusion criteria. The efficacy and safety of all outcomes which included myocardial infarction (MI), all-cause death, stroke, and bleeding were calculated. The overall outcomes analysis showed there was no significant difference in the risk of MI (relative ratio [RR] 0...
October 26, 2016: Herz
https://www.readbyqxmd.com/read/27769754/long-term-prognostic-value-of-a-negative-work-up-for-acute-coronary-disease-in-emergency-department-chest-pain-patients-without-known-coronary-artery-disease-a-cohort-study
#20
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
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