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https://www.readbyqxmd.com/read/29663124/regional-variations-in-hospital-management-and-post-discharge-mortality-in-patients-with-non-st-segment-elevation-acute-coronary-syndrome
#1
Héctor Bueno, Xavier Rossello, Stuart Pocock, Frans Van de Werf, Chee Tang Chin, Nicolas Danchin, Stephen W-L Lee, Jesús Medina, Ana Vega, Yong Huo
BACKGROUND: Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS: 11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010-March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011-May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS)...
April 16, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/29622974/pre-hospital-and-hospital-delay-in-patients-with-non-st-elevation-acute-coronary-syndromes-in-tertiary-care
#2
G S Youssef, H H Kassem, O A Ameen, H S Al Taaban, H H Rizk
Background: Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities. Objectives: To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country. Methods: Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay)...
September 2017: The Egyptian heart journal: (EHJ): official bulletin of the Egyptian Society of Cardiology
https://www.readbyqxmd.com/read/29606324/comparison-of-outcomes-and-intervention-among-patients-with-non-st-segment-elevation-acute-myocardial-infarction-of-those-with-a-left-circumflex-versus-those-with-a-non-left-circumflex-related-coronary-artery-from-the-elisa-3-trial
#3
Erik A Badings, Renicus S Hermanides, Salem H K The, Jan-Henk E Dambrink, Saman Rasoul, Jan Van Wijngaarden, Esther Van 't Riet, Evelien Kolkman, Wouter S Remkes, Geert Tjeerdsma, Marloes L J Van Der Wielen, Dirk J A Lok, Harry Suryapranata, Arnoud W J Van 't Hof
Previous studies found that patients with an acute coronary syndrome (ACS) due to occlusion of the left circumflex (LC) coronary artery often present without ST-elevation, leading to a delay in diagnosis and revascularization, a larger infarct size, and a worse prognosis. In this subgroup analysis of the ELISA-3 study (early or late intervention in high-risk non-ST-segment elevation acute coronary syndromes [NSTE-ACS]) incidence, characteristics and prognosis of LC-related NSTE-ACS was investigated, and the outcome of early versus late invasive strategy was compared...
February 21, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29579602/high-on-treatment-platelet-reactivity-and-outcome-in-elderly-with-non-st-segment-elevation-acute-coronary-syndrome-insight-from-the-gepress-study
#4
Roberta De Rosa, Tullio Palmerini, Stefano De Servi, Marta Belmonte, Gabriele Crimi, Stefano Cornara, Paolo Calabrò, Marco Cattaneo, Diego Maffeo, Anna Toso, Antonio Bartorelli, Cataldo Palmieri, Marco De Carlo, Davide Capodanno, Philippe Genereux, Dominick Angiolillo, Federico Piscione, Gennaro Galasso
BACKGROUND: Elderly treated with dual antiplatelet therapy after percutaneous coronary intervention (PCI) represent a challenging population because of increased risk of both ischemic and bleeding events. We aimed to investigate the association between high on-treatment platelet reactivity (HPR) and long-term outcome in elderly with non-ST-elevated acute coronary syndromes (NSTE-ACS) undergoing PCI. METHODS: Platelet reactivity was measured by vasodilator-stimulated phosphoprotein (VASP) assay at three time-points (baseline, discharge, 1 month after PCI) in 1053 NSTE-ACS patients (311 elderly) treated with clopidogrel...
May 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29531382/-temporal-evolution-of-antithrombotic-therapy-use-in-patients-with-acute-coronary-syndromes-undergoing-percutaneous-coronary-intervention-in-italy-comparison-between-the-eyeshot-and-scope-registries
#5
Leonardo De Luca, Mauro Pennacchi, Giuseppe Musumeci, Fabrizio D'Ascenzo, Pamela Gallo, Stefano Rigattieri, Antonino Granatelli, Sergio Berti, Michele Massimo Gulizia, Stefano De Servi, Leonardo Bolognese
BACKGROUND: Few data exist on temporal evolution of antithrombotic agent use in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) in Italy. We sought to compare data from the most recent prospective, multicenter, nationwide registries conducted in Italy, namely EYESHOT and SCOPE. METHODS: EYESHOT enrolled 2585 consecutive ACS patients, both ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS), admitted to 203 Italian coronary care units over a 3-week period (2-22 Dec 2013 and 27 Jan-16 Feb 2014)...
February 2018: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29486987/multivessel-vs-culprit-only-revascularization-in-patients-with-non-st-elevation-acute-coronary-syndromes-and-multivessel-coronary-disease
#6
César Correia, Carlos Galvão Braga, Juliana Martins, Carina Arantes, Glória Abreu, Catarina Quina, Alberto Salgado, Miguel Álvares Pereira, João Costa, Jorge Marques
INTRODUCTION: There have been no prospective randomized trials that enable the best strategy and timing to be determined for revascularization in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and multivessel coronary artery disease (CAD). OBJECTIVES: To compare short- and long-term adverse events following multivessel vs. culprit-only revascularization in patients with NSTE-ACS and multivessel CAD. METHODS: This was a retrospective observational study that included all patients diagnosed with NSTE-ACS and multivessel CAD who underwent percutaneous coronary intervention (PCI) between January 2010 and June 2013 (n=232)...
February 24, 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29447786/high-sensitivity-cardiac-troponin-t-left-ventricular-function-and-outcome-in-non-st-elevation-acute-coronary-syndrome
#7
K M Eggers, T Jernberg, B Lindahl
BACKGROUND: Cardiac troponin (cTn) levels reflect infarct size and depressed left ventricular ejection fraction (LVEF) in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). However, there is very limited information on whether cTn measured with a high-sensitivity (hs) assay would provide incremental prognostic information to the LVEF in NSTE-ACS patients. METHODS: This was a registry-based study (SWEDEHEART registry) investigating 20,652 NSTE-ACS patients with available information on hs-cTnT (highest level recorded during the hospitalization) and the LVEF estimated using echocardiography...
March 2018: American Heart Journal
https://www.readbyqxmd.com/read/29446567/prognostic-value-of-the-index-of-microcirculatory-resistance-after-percutaneous-coronary-intervention-in-patients-with-non-st-segment-elevation-acute-coronary-syndrome
#8
Tadashi Murai, Taishi Yonetsu, Yoshihisa Kanaji, Eisuke Usui, Masahiro Hoshino, Masahiro Hada, Rikuta Hamaya, Yoshinori Kanno, Tetsumin Lee, Tsunekazu Kakuta
BACKGROUND: The prognostic value of physiological indices in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing percutaneous coronary intervention (PCI) is unknown. We investigated the prognostic efficacy of physiological indices obtained after PCI in patients with NSTE-ACS. METHODS: Eighty-three patients (men: n = 70, age: 63.7 ± 9.7 years) undergoing PCI for NSTE-ACS within 48 hr postadmission were investigated. Fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR) of the culprit vessels were measured after the completion of PCI...
February 15, 2018: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29439831/routine-invasive-versus-selective-invasive-strategy-in-elderly-patients-older-than-75-years-with-non-st-segment-elevation-acute-coronary-syndrome-a-systematic-review-and-meta-analysis
#9
Aakash Garg, Lohit Garg, Manyoo Agarwal, Amit Rout, Hitesh Raheja, Sahil Agrawal, Sunil V Rao, Marc Cohen
OBJECTIVE: To evaluate outcomes of routine invasive strategy (RIS) compared with selective invasive strategy (SIS) in elderly patients older than 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: We systematically searched databases for randomized controlled trials (RCTs) between January 1, 1990, and October 1, 2016, comparing RIS with SIS for elderly patients (age>75 years) with NSTE-ACS. Random effects meta-analysis was conducted to estimate odds ratio (OR) with 95% CIs for composite of death or myocardial infarction (MI), and individual end points of all-cause death, cardiovascular (CV) death, MI, revascularization, and major bleeding...
February 10, 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29434090/determinants-and-long-term-outcomes-of-percutaneous-coronary-interventions-vs-surgery-for-multivessel-disease-according-to-clinical-presentation
#10
Sung-Jin Hong, Byeong-Keuk Kim, Sanghoon Shin, Yongsung Suh, Seunghwan Kim, Chul-Min Ahn, Jung-Sun Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang
BACKGROUND: The long-term outcome of percutaneous coronary intervention (PCI) vs. coronary artery bypass graft (CABG), particularly for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), remains controversial.Methods and Results:We retrospectively analyzed 2,827 patients (stable coronary artery disease [SCAD], n=1,601; NSTE-ACS, n=1,226) who underwent either PCI (n=1,732) or CABG (n=1,095). The 8-year composite of cardiac death and myocardial infarction (MI) was compared between PCI and CABG before and after propensity matching...
February 9, 2018: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29417147/direct-oral-anticoagulants-in-addition-to-antiplatelet-therapy-for-secondary-prevention-after-acute-coronary-syndromes-a-systematic-review-and-meta-analysis
#11
Mauro Chiarito, Davide Cao, Francesco Cannata, Cosmo Godino, Corrado Lodigiani, Giuseppe Ferrante, Renato D Lopes, John H Alexander, Bernhard Reimers, Gianluigi Condorelli, Giulio G Stefanini
Importance: Patients with acute coronary syndrome (ACS) remain at high risk for experiencing recurrent ischemic events. Direct oral anticoagulants (DOAC) have been proposed for secondary prevention after ACS. Objective: To evaluate the safety and efficacy of DOAC in addition to antiplatelet therapy (APT) after ACS, focusing on treatment effects stratified by baseline clinical presentation (non-ST-segment elevation ACS [NSTE-ACS] vs ST-segment elevation myocardial infarction [STEMI])...
March 1, 2018: JAMA Cardiology
https://www.readbyqxmd.com/read/29409525/pre-hospital-transthoracic-echocardiography-for-early-identification-of-non-st-elevation-myocardial-infarction-in-patients-with-acute-coronary-syndrome
#12
Ingo Bergmann, Benedikt Büttner, Elena Teut, Claudius Jacobshagen, José Hinz, Michael Quintel, Ashham Mansur, Markus Roessler
BACKGROUND: Non-ST elevation myocardial infarction (NSTEMI) is a common manifestation of acute coronary syndrome (ACS), but delayed diagnosis can increase mortality. In this proof of principle study, the emergency physician performed transthoracic echocardiography (TTE) on scene to determine whether NSTEMI could be correctly diagnosed pre-hospitalization. This could expedite admission to the appropriate facility and reduce the delay until initiation of correct therapy. METHODS: Pre-hospital TTE was performed on scene by the emergency physician in patients presenting with ACS but without ST-elevation in the initial 12-lead electrocardiography (ECG) (NSTE-ACS)...
February 7, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29361323/accuracy-of-the-timi-and-grace-scores-in-predicting-coronary-disease-in-patients-with-non-st-elevation-acute-coronary-syndrome
#13
Rania Hammami, Jihen Jdidi, Fakher Mroua, Rahma Kallel, Mourad Hentati, Leila Abid, Samir Kammoun
INTRODUCTION: The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease. METHODS: We analyzed 238 consecutive patients admitted for NSTE-ACS and undergoing a coronary angiogram during hospitalization. The severity of CAD was assessed using the SYNTAX score...
January 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29356001/early-versus-delayed-invasive-strategy-for-intermediate-and-high-risk-acute-coronary-syndromes-managed-without-p2y-12-receptor-inhibitor-pretreatment-design-and-rationale-of-the-early-randomized-trial
#14
Gilles Lemesle, Marc Laine, Mathieu Pankert, Etienne Puymirat, Thomas Cuisset, Ziad Boueri, Luc Maillard, Sébastien Armero, Guillaume Cayla, Laurent Bali, Pascal Motreff, Jean-Pascal Peyre, Franck Paganelli, François Kerbaul, Antoine Roch, Pierre Michelet, Karine Baumstarck, Laurent Bonello
According to recent literature, pretreatment with a P2Y12 ADP receptor antagonist before coronary angiography appears no longer suitable in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) due to an unfavorable risk-benefit ratio. Optimal delay of the invasive strategy in this specific context is unknown. We hypothesize that without P2Y12 ADP receptor antagonist pretreatment, a very early invasive strategy may be beneficial. The EARLY trial (Early or Delayed Revascularization for Intermediate- and High-Risk Non-ST-Segment Elevation Acute Coronary Syndromes?) is a prospective, multicenter, randomized, controlled, open-label, 2-parallel-group study that plans to enroll 740 patients...
January 2018: Clinical Cardiology
https://www.readbyqxmd.com/read/29336914/switching-from-clopidogrel-to-prasugrel-to-protect-early-invasive-treatment-in-acute-coronary-syndromes-results-of-the-switch-over-trial
#15
Filippo Ottani, Eti Alessandra Femia, Marco Cattaneo, Luciano Caravita, Chiara Attanasio, Marcello Galvani
BACKGROUND: Clopidogrel is used to pretreat patients with non-ST elevation acute coronary syndromes (NSTE-ACS), but prasugrel provides better platelet inhibition with improved outcome. However, switching from clopidogrel at the time of percutaneous coronary intervention (PCI) remains incompletely defined. Our aim was to compare the pharmacodynamic (PD) effects of 3 prasugrel loading doses (LDs; G1:10mg, G2: 30mg, and G3: 60mg) before PCI. A fourth group, continuing clopidogrel, served as control (G4)...
March 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29276176/coronary-aneurysms-in-the-acute-patient-incidence-characterization-and-long-term-management-results
#16
Iván J Núñez-Gil, Belén Terol, Gisela Feltes, Luis Nombela-Franco, Pablo Salinas, Javier Escaned, Pilar Jiménez-Quevedo, Nieves Gonzalo, David Vivas, Daniel Bautista, Carlos Macaya, Antonio Fernández-Ortiz
BACKGROUND: Coronary aneurysms (1.5 times dilation the reference-vessel) are uncommon and have been diagnosed with increasing frequency with coronary angiography. The incidence varies from 1.5% to 5%. Reported complications are multiple: thrombosis, distal embolization, rupture and vasospasm, causing ischemia, heart failure or arrhythmias. However, the natural history and prognosis remains obscure. We aimed to describe the characteristics of acute patients with coronary aneurysms. METHODS: Prospective coronariography registry of patients with the diagnosis of coronary aneurysm between 2002 and 2013...
December 6, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29230658/guidelines-in-review-comparison-of-the-2014-aha-acc-guideline-for-the-management-of-patients-with-non-st-elevation-acute-coronary-syndromes-and-the-2015-esc-guidelines-for-the-management-of-acute-coronary-syndromes-in-patients-presenting-without-persistent
#17
Shane P Prejean, Munaib Din, Eliana Reyes, Fadi G Hage
In this Guidelines in Review, we review side-by-side the recommendations provided by the 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. We review the recommendations for imaging in the evaluation of patients with possible ACS followed by the diagnostic evaluation of patients with proven NSTE-ACS, based on their risk for adverse clinical events...
December 11, 2017: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/29230180/immediate-early-vs-delayed-invasive-strategy-for-patients-with-non-st-segment-elevation-acute-coronary-syndromes-a-systematic-review-and-meta-analysis
#18
REVIEW
Yanda Li, Zhenpeng Zhang, Xingjiang Xiong, William C Cho, Dan Hu, Yonghong Gao, Hongcai Shang, Yanwei Xing
Invasive coronary revascularization has been shown to improve prognoses in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), but the optimal timing of intervention remains unclear. This meta-analysis is to evaluate the outcomes in immediate (<2 h), early (<24 h), and delayed invasive group and find out which is the optimal timing of intervention in NSTE-ACS patients. Studies were identified through electronic literature search of Medline, PubMed Central, Embase, the Cochrane Library, and CNKI...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/29206072/cigarette-smoking-reduces-platelet-reactivity-independently-of-clopidogrel-treatment-in-patients-with-non-st-elevation-acute-coronary-syndromes
#19
Gabriele Crimi, Alberto Somaschini, Marco Cattaneo, Dominick J Angiolillo, Federico Piscione, Tullio Palmerini, Stefano De Servi
Smokers receiving clopidogrel show a lower residual platelet reactivity than non-smokers, a phenomenon generally ascribed to smoking-induced increased production of clopidogrel active metabolite, but also associated with the high hemoglobin levels of smokers, which decreases platelet reactivity in tests that measure platelet function in whole blood. We evaluated the impact of cigarette smoking and of hemoglobin levels on platelet reactivity index (PRI) measured by the vasodilator-stimulated phosphoprotein phosphorylation (VASP-P) assay in whole blood samples from patients with non-ST elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary interventions, both before and after clopidogrel administration...
December 5, 2017: Platelets
https://www.readbyqxmd.com/read/29200825/efficacy-and-safety-of-quadruple-therapy-including-tirofiban-in-the-treatment-of-chinese-nste-acs-patients-failing-to-receive-timely-percutaneous-coronary-intervention
#20
Lan Li, Zhenrong Ge, Dengke Zhang, Jun Kuang, Xiang Ma, Shubin Jiang
Background: Although it has been shown to be superior to simple antithrombotic drug therapy, most patients are unable to receive timely percutaneous coronary intervention (PCI) and are treated with conventional triple antithrombotic therapy (aspirin, clopidogrel, low-molecular-weight heparin). Here, we evaluate the efficacy and safety of adding low-dose tirofiban to this regimen. Methods: A total of 1,783 patient records (unable to receive PCI) indicating non-ST-segment elevation acute coronary syndrome (NSTE-ACS) were included...
2017: Drug Design, Development and Therapy
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