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Andrew R Chapman, Atul Anand, Jasper Boeddinghaus, Amy V Ferry, Dennis Sandeman, Philip D Adamson, Jack P Andrews, Stephanie Tan, Sheun F Cheng, Michelle D'Souza, Kate Orme, Fiona E Strachan, Thomas Nestelberger, Raphael Twerenbold, Patrick Badertscher, Tobias Reichlin, Alasdair Gray, Anoop S V Shah, Christian Mueller, David E Newby, Nicholas L Mills
BACKGROUND: -High-sensitivity cardiac troponin assays enable myocardial infarction to be ruled out earlier, but the optimal approach is uncertain. We compared the European Society of Cardiology (ESC) rule-out pathway, with a pathway that incorporates lower cardiac troponin concentrations to risk stratify patients. METHODS: -Patients with suspected acute coronary syndrome (n=1,218) underwent high-sensitivity cardiac troponin I measurement at presentation, 3 and 6 or 12 hours...
December 29, 2016: Circulation
Tatsuya Nakachi, Masami Kosuge, Naoki Iinuma, Hidekuni Kirigaya, Shingo Kato, Kazuki Fukui, Kazuo Kimura
BACKGROUND: Several studies have shown higher early mortality for ST-segment elevation acute coronary syndrome (STEACS), but late mortality remains consistently higher for non-ST-segment elevation acute coronary syndrome (NSTEACS). We hypothesized that ST-segment category at acute presentation is associated with the time course of coronary artery disease progression (CP) of nonculprit lesions in patients with acute coronary syndrome (ACS). METHODS: A total of 226 patients (182 men, age 65 ± 10 years) with STEACS (n = 95) or NSTEACS (n = 131) who underwent percutaneous coronary intervention (PCI) during initial hospitalization were studied...
November 8, 2016: Heart and Vessels
Michael DeGiorgio, Noah A Rosenberg
In the last few years, several statistically consistent consensus methods for species tree inference have been devised that are robust to the gene tree discordance caused by incomplete lineage sorting in unstructured ancestral populations. One source of gene tree discordance that has only recently been identified as a potential obstacle for phylogenetic inference is ancestral population structure. In this article, we describe a general model of ancestral population structure, and by relying on a single carefully constructed example scenario, we show that the consensus methods Democratic Vote, STEAC, STAR, R(∗) Consensus, Rooted Triple Consensus, Minimize Deep Coalescences, and Majority-Rule Consensus are statistically inconsistent under the model...
August 2016: Theoretical Population Biology
Anoop S V Shah, Atul Anand, Yader Sandoval, Kuan Ken Lee, Stephen W Smith, Philip D Adamson, Andrew R Chapman, Timothy Langdon, Dennis Sandeman, Amar Vaswani, Fiona E Strachan, Amy Ferry, Alexandra G Stirzaker, Alan Reid, Alasdair J Gray, Paul O Collinson, David A McAllister, Fred S Apple, David E Newby, Nicholas L Mills
BACKGROUND: Suspected acute coronary syndrome is the commonest reason for emergency admission to hospital and is a large burden on health-care resources. Strategies to identify low-risk patients suitable for immediate discharge would have major benefits. METHODS: We did a prospective cohort study of 6304 consecutively enrolled patients with suspected acute coronary syndrome presenting to four secondary and tertiary care hospitals in Scotland. We measured plasma troponin concentrations at presentation using a high-sensitivity cardiac troponin I assay...
December 19, 2015: Lancet
Michael J Lipinski, Lowell F Satler
Intraprocedural thrombotic events (IPTE) during PCI occur in 4% of patients with NSTEACS and 12% of STEACS. IPTE increases hospital cost by $3,592. With an incidence of 4%, additional therapy to completely prevent IPTE in 100 patients would need to cost $144 to make it cost neutral. Further studies are necessary to determine cost-benefit of therapies to prevent IPTE such as cangrelor or newer P2Y12 inhibitors with more rapid onset.
July 2015: Catheterization and Cardiovascular Interventions
Carlos M Laborde, Sergio Alonso-Orgaz, Laura Mourino-Alvarez, José Moreu, Fernando Vivanco, Luis R Padial, María G Barderas
BACKGROUND: Acute coronary syndrome is the major cause of death in developed countries. Despite its high prevalence, there is still a strong need for new biomarkers which permit faster and more accurate diagnostics and new therapeutic drugs. The basis for this challenge lay in improving our understanding of the whole atherosclerotic process from atherogenesis to atherothrombosis. In this study, we conducted two different proteomic analyses of peripheral blood plasma from non-ST elevation acute coronary syndrome and ST elevation acute coronary syndrome patients vs healthy controls...
2014: Proteome Science
Karim Ratib, Mamas A Mamas, Simon G Anderson, Gurbir Bhatia, Helen Routledge, Mark De Belder, Peter F Ludman, Douglas Fraser, James Nolan
OBJECTIVES: This study sought to determine the relationships among access site practice, clinical presentation, and procedural outcomes in a large patient population. BACKGROUND: Transradial access (TRA) has been associated with improved patient outcomes in selected populations in randomized trials. It is unclear whether these outcomes are achievable in clinical practice. METHODS: Using the BCIS (British Cardiovascular Intervention Society) database, we investigated outcomes for percutaneous coronary intervention procedures undertaken between 2007 and 2012 according to access site practice...
January 2015: JACC. Cardiovascular Interventions
B B L M IJkema, J J R M Bonnier, D Schoors, M J Schalij, C A Swenne
The major initial triaging decision in acute coronary syndrome (ACS) is whether or not percutaneous coronary intervention (PCI) is the primary treatment. Current guidelines recommend primary PCI in ST-elevation ACS (STEACS) and initial antithrombotic therapy in non-ST-elevation ACS (NSTEACS). This review probes the question whether this decision can indeed be based on the ECG. Genesis of STE/NSTE ECGs depends on the coronary anatomy, collateral circulation and site of the culprit lesion. Other causes than ischaemia may also result in ST-segment changes...
November 2014: Netherlands Heart Journal
Guoxin Tong, Ningfu Wang, Yujie Zhou, Jianhang Leng, Wei Gao, Xiaoshan Tong, Yun Shen, Jianmin Yang, Xianhua Ye, Liang Zhou, Yan Gao
The predictive value of stromal cell-derived factor-1 (SDF-1) has not been established in patients with non-ST elevation acute coronary syndrome (non-STEACS). A total of 678 consecutive patients with non-STEACS and moderate to high TIMI (Thrombolysis In Myocardial Infarction) risk scores were recruited. All patients underwent an early invasive strategy and then were followed-up for 18 months for clinical events. Left ventricular remodeling was assessed by echocardiography. Plasma concentrations of SDF-1 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were analyzed...
2014: International Heart Journal
A D Érlikh, S T Matskeplishvili, N A Gratsianskiĭ, Iu I Buziashvili
AIM: To characterize inhospital management of patients (pts) with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized pts with ACS. METHODS: The registry included data on consecutive pts with ACS hospitalized with label ACS in coronary care units (CCU) or equivalents within 24 hours (h) after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 percutaneous coronary intervention [PCI] capable or "invasive") city hospitals officially treating ACS patients...
2013: Kardiologiia
Amit N Vora, Sunil V Rao
Bleeding events are the most common complications following percutaneous coronary intervention (PCI) and are associated with increases in short- and long-term mortality, nonfatal myocardial infarction, stroke, hospital length of stay, and hospital cost. Over time, there has been a decrease in periprocedural bleeding, primarily due to improvements in antithrombotic therapy; however, transradial (TR) catheterization has been shown to be an important strategy to minimize access site bleeding and potentially improve outcomes among patients with ST-segment elevation myocardial infarction...
May 2014: Current Treatment Options in Cardiovascular Medicine
Michael DeGiorgio, John Syring, Andrew J Eckert, Aaron Liston, Richard Cronn, David B Neale, Noah A Rosenberg
BACKGROUND: As it becomes increasingly possible to obtain DNA sequences of orthologous genes from diverse sets of taxa, species trees are frequently being inferred from multilocus data. However, the behavior of many methods for performing this inference has remained largely unexplored. Some methods have been proven to be consistent given certain evolutionary models, whereas others rely on criteria that, although appropriate for many parameter values, have peculiar zones of the parameter space in which they fail to converge on the correct estimate as data sets increase in size...
2014: BMC Evolutionary Biology
A D Erlikh, S T Matskeplishvili, N A Gratsianskiĭ, Iu I Buziashvili
AIM: To characterize the state of prehospital management of patients with acute coronary syndromes (ACS) using data from Moscow snapshot registry of hospitalized patients with ACS. METHODS: The registry included data on consecutive patients with ACS admitted to coronary care units or their equivalents of participating hospitals within 24 hours after onset of symptoms during one week in November 2013. Data was obtained from 32 (17 PCI capable or "invasive") city hospitals officially treating ACS patients...
2013: Kardiologiia
Michael S Lee, Michael Wolfe, Gregg W Stone
Recent literature has argued the superiority of radial access compared with femoral access for percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS). Three particular trials-RIVAL (Radial Versus Femoral Access for Coronary Intervention), RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome), and STEMI-RADIAL (ST Elevation Myocardial Infarction Treated by Radial or Femoral Approach-Randomized Multicenter Study Comparing Radial Versus Femoral Approach in Primary PCI)-demonstrated lower rates of bleeding and vascular complications with the transradial approach...
November 2013: JACC. Cardiovascular Interventions
(no author information available yet)
AIM: To assess incidence and severity of renal dysfunction as well as its prognostic value in patients with ST elevation myocardial infarction (STEMI) and multifocal atherosclerosis (MFA). MATERIAL AND METHODS: We enrolled in this study 529 patients with STEMI in whom we estimated creatinine clearance rate (eGFR) and glomerular filtration rate (eCrCl) using Cockcroft-Gault equation and Modification of Diet in Renal Disease (MDRD) formula, respectively. Duplex ultrasonography of lower extremity and extracranial arteries was performed in 423 patients on day 5-10 of hospitalization...
2013: Kardiologiia
I I Shevchenko, A D Érlikh, R R Islamov, V A Budiak, V M Provotorov, N A Gratsianskiĭ
Positive changes are declared to occur during recent years in management of hospitalized patients with acute coronary syndromes (ACS) in Russia. Most of these changes are related to availability of invasive treatment. But considerable portion of patients (pts) are still treated in hospitals without facilities for invasive myocardial revascularization (noninvasive hospitals - NIHs). Aim of this study was to compare some characteristics of management of ACS in NIHs which participated in ACS registries RECORD (2007-2008, 8 NIHs from 6 cities; n=381) and RECORD-2 (2009-2011, 3 NIHs from 3 cities, n=680)...
2013: Kardiologiia
A S Lotina, D V Dupliakov, A D Érlikh
AIM: to assess rognostic value of ECG signs of left bundle brunch block (LBBB) using database of registries of acute coronary syndromes (ACS) RECORD 1 (2007-2008) and 2 (2009-2011). MATERIAL AND METHODS: Total number of included patients was 2452, 2321 patients (94.9%) had no signs of LBBB, for 5 patients (0.2%) there was no information on the presence of LBBB. Among 126 patients (5.1%) with LBBB it was designated as "new" in 72 (2.9%), "old" in 39 (1.6%), and of "unknown duration" in 15 (0...
2013: Kardiologiia
Michael DeGiorgio, James H Degnan
To infer species trees from gene trees estimated from phylogenomic data sets, tractable methods are needed that can handle dozens to hundreds of loci. We examine several computationally efficient approaches-MP-EST, STAR, STEAC, STELLS, and STEM-for inferring species trees from gene trees estimated using maximum likelihood (ML) and Bayesian approaches. Among the methods examined, we found that topology-based methods often performed better using ML gene trees and methods employing coalescent times typically performed better using Bayesian gene trees, with MP-EST, STAR, STEAC, and STELLS outperforming STEM under most conditions...
January 1, 2014: Systematic Biology
Giancarla Scalone, Francesco Burzotta, Cristina Aurigemma, Giancarlo Pirozzolo, Carlo Trani
Bleeding complications in patients with acute coronary syndromes are a significant predictor of mortality. Trans-radial approach (TRA) is a promising strategy to reduce bleedings in patients undergoing invasive coronary procedures. Recently, two multicentre prospective randomized trials aimed to test whether TRA, compared to trans-femoral approach (TFA), may improve clinical outcome in patients with ST-elevation myocardial infarction: the RIFLE STEAC and STEMI-RADIAL. In the RIFLE STEACS, the primary endpoint of 30-day NACEs occurred in 68 patients (13...
June 2013: Reviews on Recent Clinical Trials
Petr Widimsky, Zuzana Motovska, Jorge Belardi, Patrick Serruys, Sigmund Silber, Stephan Windecker, Franz-Josef Neumann
BACKGROUND: Outcome data are limited in patients with ST-segment elevation acute myocardial infarction (STEMI) or other acute coronary syndromes (ACSs) who receive a drug-eluting stent (DES). Data suggest that first generation DES is associated with an increased risk of stent thrombosis when used in STEMI. Whether this observation persists with newer generation DES is unknown. The study objective was to analyze the two-year safety and effectiveness of Resolute™ zotarolimus-eluting stents (R-ZESs) implanted for STEMI, ACS without ST segment elevation (non-STEACS), and stable angina (SA)...
October 9, 2013: International Journal of Cardiology
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