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treatment non ST elevation 2014

Ahmed Al-Mamary, Filippo Zilio, Massimo Napodano
Optimal management of multivessel coronary artery disease can be complex. We report a 67-year-old male patient who was admitted to the Padua University Hospital, Padua, Italy, in 2014 with a non-ST-elevation myocardial infarction. Coronary angiography showed diffuse multiple sub-occlusive lesions of the proximal and distal left coronary vessels involving a long segment of the vessel. On intravascular ultrasonography (IVUS), the left main artery was moderately diseased with critically stenotic and calcified branch ostia...
August 2016: Sultan Qaboos University Medical Journal
Lars Wallentin, Lars Lindhagen, Elisabet Ärnström, Steen Husted, Magnus Janzon, Søren Paaske Johnsen, Frederic Kontny, Tibor Kempf, Lars-Åke Levin, Bertil Lindahl, Mats Stridsberg, Elisabeth Ståhle, Per Venge, Kai C Wollert, Eva Swahn, Bo Lagerqvist
BACKGROUND: The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up. METHODS: The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway...
October 15, 2016: Lancet
James Nadel, Eoin O'Dwyer, Sam Emmanuel, Justyn Huang, Sarat Cheruvu, Neville Sammel, Bruce Brew, James Otton, Cameron J Holloway
BACKGROUND: Human immunodeficiency virus (HIV) infection is considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). We analyzed the utility of coronary CTA in the assessment of CAD among HIV patients and explored whether HIV patients are at greater risk of associated morbidity and mortality compared to HIV-negative controls. METHODS: In a retrospective, single center cohort study 97 males without history of previous coronary artery disease who had undergone coronary CTA between 2011 and 2014 was analyzed, including 32 HIV positive patients and 65 matched HIV negative controls...
September 2016: Journal of Cardiovascular Computed Tomography
Johannes Tobias Neumann, Nils Arne Sörensen, Tjark Schwemer, Francisco Ojeda, Rafael Bourry, Vanessa Sciacca, Sarina Schaefer, Christoph Waldeyer, Christoph Sinning, Thomas Renné, Martin Than, William Parsonage, Karin Wildi, Nataliya Makarova, Renate B Schnabel, Ulf Landmesser, Christian Mueller, Louise Cullen, Jaimi Greenslade, Tanja Zeller, Stefan Blankenberg, Mahir Karakas, Dirk Westermann
IMPORTANCE: Rapid and accurate diagnosis of acute myocardial infarction (AMI) currently constitutes an unmet need. OBJECTIVE: To test a 1-hour diagnostic algorithm to diagnose AMI using a high-sensitivity troponin I assay with a new cutoff level of 6 ng/L. DESIGN, SETTING, AND PARTICIPANTS: The Biomarkers in Acute Cardiac Care study is a prospective study that investigated the application of the troponin I assay for the diagnosis of AMI in 1040 patients presenting to the emergency department with acute chest pain from July 19, 2013, to December 31, 2014...
July 1, 2016: JAMA Cardiology
Juan Sanchis, Eduardo Núñez, José Antonio Barrabés, Francisco Marín, Luciano Consuegra-Sánchez, Silvia Ventura, Ernesto Valero, Mercè Roqué, Antoni Bayés-Genís, Bruno García Del Blanco, Irene Dégano, Julio Núñez
BACKGROUND: Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. METHODS: Randomized multicenter study, including 106 patients (January 2012-March 2014) with non-STEMI, over 70years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia...
July 13, 2016: European Journal of Internal Medicine
Harindra C Wijeysundera, Mandeep S Sidhu, Maria C Bennell, Feng Qiu, Dennis T Ko, Merril L Knudtson, Jack V Tu, William E Boden
BACKGROUND: Although an invasive strategy is a class I clinical practice guideline for non-ST-segment-elevation acute coronary syndromes, there is wide variation in the proportion of patients who undergo revascularization despite early angiography. We sought to identify the predictors of early revascularization versus medical therapy alone in patients with non-ST-segment-elevation acute coronary syndrome undergoing an invasive strategy and to assess their clinical outcomes. METHODS AND RESULTS: We assessed revascularization status by percutaneous coronary intervention or coronary artery bypass grafting within 7 days of the index angiogram in all patients with non-ST-segment-elevation acute coronary syndrome who underwent an invasive strategy in Ontario, Canada, from October 1, 2008, to October 31, 2013, with follow-up through December 31, 2014...
July 2016: Circulation. Cardiovascular Interventions
Fatima Rodriguez, Kenneth W Mahaffey
Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide. The American Heart Association/American College of Cardiology and the European Society of Cardiology periodically release practice guidelines to guide clinicians in the management of NSTE-ACS, most recently in in 2014 and 2015, respectively. The present review compares and contrasts the 2 guidelines, with a focus on the strength of recommendation and level of evidence in the approach to initial presentation and diagnosis of NSTE-ACS, risk assessment, treatments, and systems of care...
July 19, 2016: Journal of the American College of Cardiology
Bárbara Campos Abreu Marino, Milena Soriano Marcolino, Rasível Dos Santos Reis Júnior, Ana Luiza Nunes França, Priscilla Fortes de Oliveira Passos, Thais Ribeiro Lemos, Izabella de Oliveira Antunes, Camila Gonçalves Ferreira, André Pires Antunes, Antonio Luiz Pinho Ribeiro
BACKGROUND: Coronary artery disease is the main cause of death in Brazil. In the Brazilian public health system, the in-hospital mortality associated with acute myocardial infarction is high. The Minas Telecardio 2 Project (Projeto Minas Telecardio 2) aims at implementing a myocardial infarction system of care in the Northern Region of Minas Gerais (MG) to decrease hospital morbidity and mortality. The aim of this study was to describe the profile of the patients with acute coronary syndrome (ACS) cared for in the period that preceded the implementation of the system of care...
August 2016: Arquivos Brasileiros de Cardiologia
Rajasekhar D, Vanajakshamma V, Vamsidhar A, Boochi Babum M, Latheef K
BACKGROUND: India has the highest burden of coronary artery disease in the world. It also has a higher rate of STsegment elevation myocardial infarction than that in developed countries. Primary percutaneous coronary intervention is an effective treatment, yet little is known about its feasibility and outcome in India. We studied the outcomes of primary percutaneous coronary intervention at an Indian tertiary care centre. METHODS: We did a prospective observational study of 1000 consecutive patients with ST-segment elevation myocardial infarction, who were treated with primary percutaneous coronary intervention from December 2010 to May 2014 at Sri Venkateswara Institute of Medical Sciences, Tirupati, India...
November 2015: National Medical Journal of India
Ambarish Pandey, Darren K McGuire, James A de Lemos, Sandeep R Das, Jarett D Berry, Emmanouil S Brilakis, Subhash Banerjee, Steven P Marso, Gregory W Barsness, DaJuanicia N Simon, Matthew Roe, Abhinav Goyal, Mikhail Kosiborod, Ezra A Amsterdam, Dharam J Kumbhani
BACKGROUND: Current guidelines recommend surgical revascularization (coronary artery bypass graft [CABG]) over percutaneous coronary intervention (PCI) in patients with diabetes mellitus and multivessel coronary artery disease. Few data are available describing revascularization patterns among these patients in the setting of non-ST-segment-elevation myocardial infarction. METHODS AND RESULTS: Using Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines (ACTION Registry-GWTG), we compared the in-hospital use of different revascularization strategies (PCI versus CABG versus no revascularization) in diabetes mellitus patients with non-ST-segment-elevation myocardial infarction who had angiography, demonstrating multivessel coronary artery disease between July 2008 and December 2014...
May 2016: Circulation. Cardiovascular Quality and Outcomes
Josien Engel, Nikki L Damen, Ineke van der Wulp, Martine C de Bruijne, Cordula Wagner
BACKGROUND: In the management of non-ST-elevation acute coronary syndrome (NST-ACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking. OBJECTIVE: To examine the extent of guideline adherence, to study associations with the occurrence of adverse cardiac events, and to identify factors associated with guideline adherence...
May 3, 2016: Current Cardiology Reviews
Lia Amalia, Kusnandar Anggadireja, Toni M Aprami, Vina Septiani
Adverse drug reactions (ADRs) are associated with morbidity, mortality, and can contribute to increased healthcare costs. This study was conducted to identify the occurence, types, and management of ADRs, as well as analyze the causal relationship, severity, and preventability of ADRs. The study was observational analysis with concurrent data collection from patients with Coronary Artery Disease-ST segment Elevation Myocardial Infarction (CAD-STEMI) treated in the Cardiac Intensive Care Unit (CICU) at a hospital in Bandung Indonesia, during the period of December 2013 to March 2014...
2016: Scientia Pharmaceutica
Michelle L O'Donoghue, Ruchira Glaser, Matthew A Cavender, Philip E Aylward, Marc P Bonaca, Andrzej Budaj, Richard Y Davies, Mikael Dellborg, Keith A A Fox, Jorge Antonio T Gutierrez, Christian Hamm, Robert G Kiss, František Kovar, Julia F Kuder, Kyung Ah Im, John J Lepore, Jose L Lopez-Sendon, Ton Oude Ophuis, Alexandr Parkhomenko, Jennifer B Shannon, Jindrich Spinar, Jean-Francois Tanguay, Mikhail Ruda, P Gabriel Steg, Pierre Theroux, Stephen D Wiviott, Ian Laws, Marc S Sabatine, David A Morrow
IMPORTANCE: p38 Mitogen-activated protein kinase (MAPK)-stimulated inflammation is implicated in atherogenesis, plaque destabilization, and maladaptive processes in myocardial infarction (MI). Pilot data in a phase 2 trial in non-ST elevation MI indicated that the p38 MAPK inhibitor losmapimod attenuates inflammation and may improve outcomes. OBJECTIVE: To evaluate the efficacy and safety of losmapimod on cardiovascular outcomes in patients hospitalized with an acute myocardial infarction...
April 19, 2016: JAMA: the Journal of the American Medical Association
Charan Yerasi, Edward Koifman, Gaby Weissman, Zuyue Wang, Rebecca Torguson, Jiaxiang Gai, Joseph Lindsay, Lowell F Satler, Augusto D Pichard, Ron Waksman, Itsik Ben-Dor
BACKGROUND: Takotsubo syndrome is also known as stress cardiomyopathy because of the regularity with which it has been associated with physical or emotional stress. Such stress may well be a "trigger" of the syndrome. AIMS: This analysis was undertaken to describe our experience with this disorder and in particular to examine the effects of the underlying trigger on outcomes. METHODS: We conducted a retrospective review of the medical records of 345 consecutive patients treated at our institution from 2006 to 2014...
February 17, 2016: European Heart Journal. Acute Cardiovascular Care
Rodel V Bobadilla
The American Heart Association/American College of Cardiology in 2014 published a focused update of the 2007 and 2012 guidelines for non-ST-segment elevation acute coronary syndrome (NSTE-ACS). The management of ST-segment elevation myocardial infarction (STEMI) is described in a separate guideline published in 2013. The focused updates to the guidelines contain updated recommendations for dual antiplatelet therapy, including use of the P2Y12 inhibitor ticagrelor, which was recently approved by the Food and Drug Administration...
February 2016: Critical Care Nurse
David M Shavelle
Recent years have seen major advances in the evaluation and treatment of patients with coronary artery disease. These include assessment of novel biomarkers and imaging methods for patients at risk for coronary artery disease, care of patients with ST-segment elevation myocardial infarction, a novel device to treat medical refractory angina, use of non-statin lipid-lowering agents, a better understanding of the risks and benefits of long-term dual antiplatelet therapy and the use of the newer antiplatelet agents...
April 2016: Heart: Official Journal of the British Cardiac Society
Wei-Chieh Lee, Chiung-Jen Wu, Yung-Lung Chen, Wen-Jung Chung, Shu-Kai Hsueh, Chi-Ling Hang, Chih-Yuan Fang, Hsiu-Yu Fang
Percutaneous coronary interventions (PCIs) with drug-eluting balloons (DEBs) have emerged as an adjunctive treatment for in-stent restenosis (ISR) lesions. However, recurrent restenosis still occurs following DEB use. Our study aimed to identify the associations of target lesion restenosis following DEB use over a 1-year clinical follow-up.Between November 2011 and May 2014, 246 patients were diagnosed with coronary artery ISR in our hospital. A total of 335 coronary ISR lesions were treated with DEBs. The 1-year patent coronary artery group was defined as those with negative noninvasive examinations and no clinical symptoms, or those with no angiographic restenosis...
January 2016: Medicine (Baltimore)
Nicolai Tegn, Michael Abdelnoor, Lars Aaberge, Knut Endresen, Pål Smith, Svend Aakhus, Erik Gjertsen, Ola Dahl-Hofseth, Anette Hylen Ranhoff, Lars Gullestad, Bjørn Bendz
BACKGROUND: Non-ST-elevation myocardial infarction (NSTEMI) and unstable angina pectoris are frequent causes of hospital admission in the elderly. However, clinical trials targeting this population are scarce, and these patients are less likely to receive treatment according to guidelines. We aimed to investigate whether this population would benefit from an early invasive strategy versus a conservative strategy. METHODS: In this open-label randomised controlled multicentre trial, patients aged 80 years or older with NSTEMI or unstable angina admitted to 16 hospitals in the South-East Health Region of Norway were randomly assigned to an invasive strategy (including early coronary angiography with immediate assessment for percutaneous coronary intervention, coronary artery bypass graft, and optimum medical treatment) or to a conservative strategy (optimum medical treatment alone)...
March 12, 2016: Lancet
Linda Worrall-Carter, Samantha McEvedy, Lisa Kuhn, Elizabeth Scruth, Andrew MacIsaac, Muhammad Aziz Rahman
BACKGROUND: Guidelines recommend that all non-ST-segment elevation acute coronary syndrome (NSTEACS) patients with high-risk features receive a coronary angiogram. We hypothesised that the widely reported gender disparity in the use of angiography might be the result of women more frequently being stratified into the lower-risk category. OBJECTIVES: The aim of the study was to review studies reporting risk stratification of NSTEACS patients by gender, compare risk profiles, and assess impact on use of coronary angiography...
November 5, 2015: Journal of Cardiovascular Nursing
Manel Sabaté, Stephan Windecker, Andres Iñiguez, Lisette Okkels-Jensen, Angel Cequier, Salvatore Brugaletta, Sjoerd H Hofma, Lorenz Räber, Evald Høi Christiansen, Maarten Suttorp, Thomas Pilgrim, Gerrit Anne van Es, Yohei Sotomi, Hector M García-García, Yoshinobu Onuma, Patrick W Serruys
AIMS: Patients with ST-segment elevation myocardial infarction (STEMI) feature thrombus-rich lesions with large necrotic core, which are usually associated with delayed arterial healing and impaired stent-related outcomes. The use of bioresorbable vascular scaffolds (Absorb) has the potential to overcome these limitations owing to restoration of native vessel lumen and physiology at long term. The purpose of this randomized trial was to compare the arterial healing response at short term, as a surrogate for safety and efficacy, between the Absorb and the metallic everolimus-eluting stent (EES) in patients with STEMI...
January 14, 2016: European Heart Journal
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