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https://www.readbyqxmd.com/read/29227414/the-diagnostic-process-of-stable-angina-still-many-doubts-since-heberden-s-first-description-250-years-ago
#1
Irene Raso, Ilaria Passarelli, Gioacchino Valenti, Gabriele Crimi, Stefano de Servi
: Since Heberden's first description, stable angina has represented a challenge for the clinicians. Even the most recent guidelines seem ineffective to correctly identify patients who should be sent to cath labs. Still too many patients who undergo coronary angiography are found not to have significant lesions; moreover, its extensive use as the first diagnostic test leads to revascularizations with uncertain appropriateness and prognostic significance. These considerations underline the importance of noninvasive testing before sending patients to invasive coronary angiography...
December 8, 2017: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/29225937/use-of-standardised-patients-to-assess-quality-of-healthcare-in-nairobi-kenya-a-pilot-cross-sectional-study-with-international-comparisons
#2
Benjamin Daniels, Amy Dolinger, Guadalupe Bedoya, Khama Rogo, Ana Goicoechea, Jorge Coarasa, Francis Wafula, Njeri Mwaura, Redemptar Kimeu, Jishnu Das
Introduction: The quality of clinical care can be reliably measured in multiple settings using standardised patients (SPs), but this methodology has not been extensively used in Sub-Saharan Africa. This study validates the use of SPs for a variety of tracer conditions in Nairobi, Kenya, and provides new results on the quality of care in sampled primary care clinics. Methods: We deployed 14 SPs in private and public clinics presenting either asthma, child diarrhoea, tuberculosis or unstable angina...
2017: BMJ Global Health
https://www.readbyqxmd.com/read/29208494/bleeding-in-advanced-ckd-patients-on-antithrombotic-medication-a-critical-appraisal
#3
Alexandru Burlacu, Simonetta Genovesi, David Goldsmith, Patrick Rossignol, Alberto Ortiz, Philip A Kalra, Jolanta Małyszko, Maciej Banach, Mehmet Kanbay, Adrian Covic
Patients with advanced chronic kidney disease (CKD) are at an increased risk of bleeding, especially in the context of the complex therapeutic schemes of coronary artery disease (CAD) (from stable angina to acute coronary syndromes), atrial fibrillation or venous thromboembolism. The bleeding issue increases morbidity and mortality, a serious problem in daily medical practice. However, these patients are largely excluded from major randomized clinical trials, which results in the lack of medical evidence-based foundation for specific recommendations regarding antithrombotic treatment in a high bleeding risk setting...
December 2, 2017: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
https://www.readbyqxmd.com/read/29200864/efficacy-of-noninvasive-cardiac-imaging-tests-in-diagnosis-and-management-of-stable-coronary-artery-disease
#4
REVIEW
Ify R Mordi, Athar A Badar, R John Irving, Jonathan R Weir-McCall, J Graeme Houston, Chim C Lang
The aim of this review was to discuss the current literature regarding the utility of noninvasive imaging in diagnosis and management of stable coronary artery disease (CAD) including recent data from large randomized trials assessing diagnosis and prognosis. Current guidelines recommend revascularization in patients with refractory angina and in those with potential prognostic benefit. Appropriate risk stratification through noninvasive assessment is important in ensuring patients are not exposed to unnecessary invasive coronary angiograms...
2017: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/29168689/in-hospital-prescriptions-of-secondary-prevention-medications-for-post-acute-coronary-syndrome-patients-in-south-korea%C3%A2
#5
Han-Bin Kang, Minwook Choi, Sang Gyeong Yoon, Young Seuk Cho, Nam Kyung Je
BACKGROUND: Optimal medical therapy and the management of cardiac risk factors are crucial for the secondary prevention of acute coronary syndrome (ACS). However, there have been reports on the underutilization of secondary-prevention medications for ACS. This study aimed to investigate adherence of in-hospital prescriptions to clinical practice guidelines for the secondary prevention of ACS using real-world data. MATERIALS AND METHODS: We collected information on ACS patients from national insurance claims data...
November 23, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29138258/challenges-in-delivering-computed-tomography-coronary-angiography-as-the-first-line-test-for-stable-chest-pain
#6
John G Dreisbach, Edward D Nicol, Carl A Roobottom, Simon Padley, Giles Roditi
OBJECTIVE: The National Institute for Health and Care Excellence (NICE) clinical guidelines 'chest pain of recent onset: assessment and diagnosis' (update 2016) state CT coronary angiography (CTCA) should be offered as the first-line investigation for patients with stable chest pain. However, the current provision in the UK is unknown. We aimed to evaluate this and estimate the requirements for full implementation of the guidelines including geographical variation. Ancillary aims included surveying the number of CTCA-capable scanners and accredited practitioners in the UK...
November 14, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29135620/safety-of-a-1-hour-rule-out-high-sensitive-troponin-t-protocol-in-patients-with-chest-pain-at-the-emergency-department
#7
E Röttger, S de Vries-Spithoven, J B Reitsma, A Limburg, C E E van Ofwegen-Hanekamp, A W Hoes, J M Poldervaart
BACKGROUND: The 1-hour rule-out high-sensitive cardiac troponin T protocol (hs-cTnT), in which a serial troponin measurement is performed 1 hour after the first to assess the possibility of acute coronary syndrome (ACS), has been implemented in the European guidelines in 2015. Our aim was to assess the safety of this protocol in low-risk patients in the Emergency Department (ED) when implemented in daily practice. METHODS: Patients with acute chest pain presenting to the ED of our hospital and younger than 75 years were included (May 2013 to October 2014, The Netherlands)...
December 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/29117276/clinical-efficacy-and-safety-of-evolocumab-in-high-risk-patients-receiving-a-statin-secondary-analysis-of-patients-with-low-ldl-cholesterol-levels-and-in-those-already-receiving-a-maximal-potency-statin-in-a-randomized-clinical-trial
#8
Robert P Giugliano, Anthony Keech, Sabina A Murphy, Kurt Huber, S Lale Tokgozoglu, Basil S Lewis, Jorge Ferreira, Armando Lira Pineda, Ransi Somaratne, Peter S Sever, Terje R Pedersen, Marc S Sabatine
Importance: Current guidelines for atherosclerotic cardiovascular disease focus on high-intensity statins and targeting or using a threshold low-density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dL for the highest-risk patients. Whether further reduction of LDL-C beyond these boundaries would be beneficial is unknown. Objective: To compare outcomes of evolocumab vs placebo in patients with stable atherosclerotic cardiovascular disease and a baseline LDL-C of less than 70 mg/dL and in those receiving background treatment with a maximal-potency statin...
November 8, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29046004/-coronary-computed-tomography-angiography-in-patients-with-stable-coronary-artery-disease
#9
Helen Ullrich, Tommaso Gori
The guidelines on the management of stable coronary artery disease (SCAD) recommend the use of coronary computed tomography angiography (CTA) in the process of diagnosing coronary artery disease in patients with low intermediate pre-test probability for SCAD. Particularly in cases where stress electrocardiogram or stress imaging provides unclear results, a computed tomographic examination can be considered as a reliable alternative to invasive coronary angiography. Due to its high negative predictive value, coronary CTA can provide accurate information on the presence of coronary artery stenosis and thus coronary artery disease can be reliably excluded without the risks associated with invasive procedures...
October 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29044298/the-performance-of-crusade-and-acuity-bleeding-risk-scores-in-ticagrelor-treated-acs-patients-who-underwent-pci
#10
Shaozhi Xi, Shanshan Zhou, Xuyun Wang, Jia Liu, Liuan Qin, Jun Liu, Tong Yin, Yundai Chen
The performance of the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) and ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) risk scores for the prediction of major bleeding in ticagrelor-treated acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI) is unknown. The aim of the present study is to validate the performance of both scores in a contemporary Chinese cohort of ACS patients hospitalized for PCI and administrated with ticagrelor...
November 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/29043405/-focused-update-on-dual-antiplatelet-treatment-esc-guidelines-2017
#11
A Schäfer, J Bauersachs
Dual antiplatelet treatment (DAPT) is a cornerstone of maintenance medication of patients following elective percutaneous coronary interventions or an acute coronary syndrome (ACS), e. g. ST elevation myocardial infarction, non-ST elevation myocardial infarction and unstable angina. In recent years the inclusion of P2Y12 inhibition in addition to low-dose acetylsalicylic acid has been intensively debated. Following the introduction of the modern generation of drug-eluting stents for elective coronary interventions, the duration of the necessary DAPT has been clearly reduced...
December 2017: Herz
https://www.readbyqxmd.com/read/29033611/stable-ischemic-heart-disease-in-women-current-perspectives
#12
REVIEW
Fatima Samad, Anushree Agarwal, Zainab Samad
Cardiovascular disease is the leading cause of death in women accounting for 1 in every 4 female deaths. Pathophysiology of ischemic heart disease in women includes epicardial coronary artery, endothelial dysfunction, coronary vasospasm, plaque erosion and spontaneous coronary artery dissection. Angina is the most common presentation of stable ischemic heart disease (SIHD) in women. Risk factors for SIHD include traditional risks such as older age, obesity (body mass index [BMI] >25 kg/m2), smoking, hypertension, dyslipidemia, cerebrovascular and peripheral vascular disease, sedentary lifestyle, family history of premature coronary artery disease, metabolic syndrome and diabetes mellitus, and nontraditional risk factors, such as gestational diabetes, insulin resistance/polycystic ovarian disease, pregnancy-induced hypertension, pre-eclampsia, eclampsia, menopause, mental stress and autoimmune diseases...
2017: International Journal of Women's Health
https://www.readbyqxmd.com/read/29031990/international-standardization-of-diagnostic-criteria-for-microvascular-angina
#13
Peter Ong, Paolo G Camici, John F Beltrame, Filippo Crea, Hiroaki Shimokawa, Udo Sechtem, Juan Carlos Kaski, C Noel Bairey Merz
Standardization of diagnostic criteria for ischemic symptoms due to coronary microvascular dysfunction (CMD) is needed for further investigation of patients presenting with anginal chest pain consistent with "microvascular angina" (MVA). At the annual Coronary Vasomotion Disorders International Study Group (COVADIS) Summits held in August 2014 and 2015, the following criteria were agreed upon for the investigative diagnosis of microvascular angina: (1) presence of symptoms suggestive of myocardial ischemia; (2) objective documentation of myocardial ischemia, as assessed by currently available techniques; (3) absence of obstructive CAD (<50% coronary diameter reduction and/or fractional flow reserve (FFR) >0...
September 8, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28993120/coronary-lumen-volume-to-myocardial-mass-ratio-in-primary-microvascular-angina
#14
Rominder Grover, Jonathon A Leipsic, John Mooney, Shaw-Hua Kueh, Mickael Ohana, Bjarne L Nᴓrgaard, Ashkan Eftekhari, Jeroen J Bax, Darra T Murphy, Cameron J Hague, Michael A Seidman, Philipp Blanke, Tara Sedlak, Stephanie L Sellers
BACKGROUND: Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA. METHODS: A retrospective case-control analysis was performed using patients fulfilling guideline criteria for MVA with controls matched for age, gender, coronary risk factors and atherosclerotic plaque burden...
September 22, 2017: Journal of Cardiovascular Computed Tomography
https://www.readbyqxmd.com/read/28958142/serum-25-hydroxy-vitamin-d-concentration-in-acute-coronary-syndrome
#15
E Anastasi, M Suppa, V Viggiani, S Tartaglione, A Angeloni, T Granato
Vitamin D may have prognostic value in cardiovascular disease (CVD) patients and, in addition to conventional biomarkers, could be a valuable tool for disease management. The aim of this study was to assess the association of vitamin D status in patients with acute coronary syndrome (ACS) and to evaluate its prognostic utility. The levels of 25(OH) vitamin D were correlated with troponin T hs. Forty-eight consecutive outpatients (40 Caucasian and 8 Asian) aged between 40 and 70 years (mean 61.5, range 43-77 years) were enrolled in the study...
July 2017: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/28940292/different-patients-different-outcomes-a-case-control-study-of-spontaneous-coronary-artery-dissection-versus-acute-coronary-syndrome
#16
Heath Adams, Elizabeth Paratz, Jithendra Somaratne, Jamie Layland, Andrew Burns, Sonny Palmer, Andrew MacIsaac, Robert Whitbourn
INTRODUCTION: There is progressive interest worldwide in spontaneous coronary artery dissection (SCAD). To identify a SCAD cohort and compare risk factors, presentation, and management outcomes compared to acute coronary syndrome (ACS) matched controls. METHODS: Retrospective analysis was performed from 2000 to 2015. Clinical data included a neuropsychiatric history, with management and clinical outcomes assessed at 12 months. Patients were matched on a 1:3 case-control basis according to type of ACS...
September 20, 2017: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/28880025/expert-consensus-document-a-diamond-approach-to-personalized-treatment-of-angina
#17
REVIEW
Roberto Ferrari, Paolo G Camici, Filippo Crea, Nicolas Danchin, Kim Fox, Aldo P Maggioni, Athanasios J Manolis, Mario Marzilli, Giuseppe M C Rosano, José L Lopez-Sendon
In clinical guidelines, drugs for symptomatic angina are classified as being first choice (β-blockers, calcium-channel blockers, short-acting nitrates) or second choice (ivabradine, nicorandil, ranolazine, trimetazidine), with the recommendation to reserve second-choice medications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. No direct comparisons between first-choice and second-choice treatments have demonstrated the superiority of one group of drugs over the other...
September 7, 2017: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/28868073/antithrombotic-treatment-tailoring-and-risk-score-evaluation-in-elderly-patients-diagnosed-with-an-acute-coronary-syndrome
#18
REVIEW
Alexandru Nicolae Mischie, Catalina Liliana Andrei, Crina Sinescu, Gani Bajraktari, Eugen Ivan, Georgios Nikolaos Chatziathanasiou, Michele Schiariti
Age is an important prognostic factor in the outcome of acute coronary syndromes (ACS). A substantial percentage of patients who experience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These patients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population...
July 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/28844992/diagnostic-and-prognostic-benefits-of-computed-tomography-coronary-angiography-using-the-2016-national-institute-for-health-and-care-excellence-guidance-within-a-randomised-trial
#19
Philip D Adamson, Amanda Hunter, Michelle C Williams, Anoop Sv Shah, David A McAllister, Tania A Pawade, Marc R Dweck, Nicholas L Mills, Colin Berry, Nicholas A Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin Jr van Beek, Adam D Timmis, David E Newby
OBJECTIVES: To evaluate the diagnostic and prognostic benefits of CT coronary angiography (CTCA) using the 2016 National Institute for Health and Care Excellence (NICE) guidelines for the assessment of suspected stable angina. METHODS: Post hoc analysis of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4146 participants with suspected angina randomised to CTCA. Patients were dichotomised into NICE guideline-defined possible angina and non-anginal presentations...
August 27, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28844035/state-of-the-art-optimal-medical-therapy-competing-with-or-complementary-to-revascularisation-in-patients-with-coronary-artery-disease
#20
Javaid Iqbal, Robert Widmer, Bernard J Gersh
The role of coronary revascularisation with PCI and CABG in patients with stable and unstable coronary artery disease (CAD) is well established and there is a general consensus among guidelines as regards the indications for coronary revascularisation. Although revascularisation has undoubtedly revolutionised the treatment of CAD, it is vital to understand the recent advances and importance of the concomitant use of evidence-based optimal medical therapy (OMT). In contemporary practice, OMT should include an antiplatelet agent (or dual antiplatelet therapy when indicated) and a lipid-lowering drug for all patients, and a beta-blocker and an ACE inhibitor (or angiotensin receptor blocker) for the vast majority of patients, along with addressing cardiac risk factors and lifestyle management...
August 25, 2017: EuroIntervention
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