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NSTEMI GUIDELINES

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https://www.readbyqxmd.com/read/27931558/time-to-shift-from-contemporary-to-high-sensitivity-cardiac-troponin-in-diagnosis-of-acute-coronary-syndromes
#1
REVIEW
Jamshed J Dalal, C K Ponde, Brian Pinto, C N Srinivas, Joy Thomas, Sunil Kumar Modi, Sanjay Mehta, Suvin Shetty, Manimarane, Bhupen Desai
Early rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis. The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of ≤10%, well below the 99th percentile value...
November 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27865680/mortality-benefit-of-long-term-angiotensin-converting-enzyme-inhibitors-or-angiotensin-receptor-blockers-after-successful-percutaneous-coronary-intervention-in-non-st-elevation-acute-myocardial-infarction
#2
María Cristina González-Cambeiro, Andrea López-López, Emad Abu-Assi, Sergio Raposeiras-Roubín, Carlos Peña-Gil, José García-Acuña, Ramón González-Juanatey
INTRODUCTION AND OBJECTIVES: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have been shown to reduce mortality after myocardial infarction (MI). Current guidelines recommend their prescription in all patients after MI. Limited data are available on whether ACEIs/ARBs still improve prognosis in the contemporary era of non-ST elevation MI (NSTEMI) management. We aimed to evaluate the mortality benefit of ACEIs/ARBs in NSTEMI patients treated successfully with percutaneous coronary intervention (PCI)...
December 2016: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/27806171/intensive-care-unit-utilization-and-mortality-among-medicare-patients-hospitalized-with-non-st-segment-elevation-myocardial-infarction
#3
Alexander C Fanaroff, Eric D Peterson, Anita Y Chen, Laine Thomas, Jacob A Doll, Christopher B Fordyce, L Kristin Newby, Ezra A Amsterdam, Mikhail N Kosiborod, James A de Lemos, Tracy Y Wang
Importance: Intensive care unit (ICU) utilization may have important implications for the care and outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI). Objectives: To examine interhospital variation in ICU utilization in the United States for older adults with hemodynamically stable NSTEMI and outcomes associated with ICU utilization among patients with low, moderate, or high mortality risk. Design, Setting, and Participants: This study was a retrospective analysis of 28 018 Medicare patients 65 years or older admitted with NSTEMI to 346 hospitals participating in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION)-Get With the Guidelines from April 1, 2011, through December 31, 2012...
November 2, 2016: JAMA Cardiology
https://www.readbyqxmd.com/read/27798246/high-intensity-atorvastatin-induced-rhabdomyolysis-in-an-elderly-patient-with-nstemi-a-case-report-and-review-of-the-literature
#4
Glen A Huynh, Audrey J Lee
A 91-year-old male was admitted to the hospital for worsening muscle weakness, muscle pain, and unexplained soreness for the past 10 days. Four months prior to his admission, the patient had experienced a myocardial infarction and was initiated on atorvastatin 80 mg daily. Although the provider had instructed the patient to decrease the atorvastatin dose to 40 mg daily 3 months prior to admission, the patient did not adhere to the lower dose regimen until 10 days prior to hospitalization. Upon admission, the patient presented with muscle weakness and pain, a serum creatinine phosphokinase of 18 723 U/L, and a serum creatinine of 1...
October 26, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27574717/association-of-clinical-factors-and-therapeutic-strategies-with-improvements-in-survival-following-non-st-elevation-myocardial-infarction-2003-2013
#5
Marlous Hall, Tatendashe B Dondo, Andrew T Yan, Shaun G Goodman, Héctor Bueno, Derek P Chew, David Brieger, Adam Timmis, Phillip D Batin, John E Deanfield, Harry Hemingway, Keith A A Fox, Christopher P Gale
IMPORTANCE: International studies report a decline in mortality following non-ST-elevation myocardial infarction (NSTEMI). Whether this is due to lower baseline risk or increased utilization of guideline-indicated treatments is unknown. OBJECTIVE: To determine whether changes in characteristics of patients with NSTEMI are associated with improvements in outcomes. DESIGN, SETTING, AND PARTICIPANTS: Data on patients with NSTEMI in 247 hospitals in England and Wales were obtained from the Myocardial Ischaemia National Audit Project between January 1, 2003, and June 30, 2013 (final follow-up, December 31, 2013)...
September 13, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27574379/spontaneous-coronary-artery-dissection-one-disease-variable-presentations-and-different-management-approaches
#6
REVIEW
Abdel Rahman A Al Emam, Ahmed Almomani, Syed A Gilani, Wissam I Khalife
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. It occurs predominantly among younger females, typically in the absence of atherosclerotic coronary artery disease. Presentations vary greatly and this condition can be fatal. Given its rarity, there are no management guidelines. We present six patients with SCAD with different presentations and treatment approaches as examples in our literature review. Two patients presented with ST elevation myocardial infarction (STEMI), two with non-STEMI (NSTEMI), and two with cardiac arrest...
September 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
https://www.readbyqxmd.com/read/27574333/impact-of-initial-hospital-diagnosis-on-mortality-for-acute-myocardial-infarction-a-national-cohort-study
#7
Jianhua Wu, Chris P Gale, Marlous Hall, Tatendashe B Dondo, Elizabeth Metcalfe, Ged Oliver, Phil D Batin, Harry Hemingway, Adam Timmis, Robert M West
AIMS: Early and accurate diagnosis of acute myocardial infarction is central to successful treatment and improved outcomes. We aimed to investigate the impact of the initial hospital diagnosis on mortality for patients with acute myocardial infarction. METHODS AND RESULTS: Cohort study using data from the Myocardial Ischaemia National Audit Project of patients discharged with a final diagnosis of ST-elevation myocardial infarction (STEMI, n=221,635) and non-STEMI (NSTEMI, n=342,777) between 1 April 2004 and 31 March 2013 in all acute hospitals (n = 243) in England and Wales...
August 29, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27573613/copeptin-for-the-early-rule-out-of-non-st-elevation-myocardial-infarction
#8
Kris G Vargas, Mona Kassem, Christian Mueller, Johann Wojta, Kurt Huber
Copeptin, a neuropeptide of unknown pathophysiological function that is stoichiometrically secreted with the antidiuretic hormone, is a non-specific marker of endogenous stress which has recently gained interest for its use within a dual-marker strategy in combination with cardiac troponin for the early rule-out of non-ST-elevation myocardial infarction (NSTEMI) in emergency department patients with suspected MI. Based on methodologically strong and consistent evidence from large diagnostic studies and even one randomized intervention study, current European Society of Cardiology Guidelines recommend copeptin and the dual-marker strategy for the early rule-out of MI when high-sensitivity cardiac troponin (hs-cTn) assays are not available...
November 15, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27522492/the-role-of-glycoprotein-iib-iiia-inhibitors-in-acute-coronary-syndromes-and-the-interference-with-anemia
#9
REVIEW
Paolo Emilio Puddu, Loredana Iannetta, Attilio Placanica, Domenico Cuturello, Michele Schiariti, Olivia Manfrini
The role played by glycoprotein (GP) IIb/IIIa inhibitors (GPI) has continuously evolved until the most recent Guidelines whereby they were stepped down from class I to class II recommendation for treating acute coronary syndromes (ACS). GPI compete with a wider use of ADP inhibitors and novel anticoagulant drugs although GPI use has greatly narrowed. However, GPI may still have a role. Several criteria were proposed to define post-PCI anemia which is strictly related to bleeding and transfusion. In ACS, it should be important to define anemia in comparative terms versus baseline levels: ≥ 15% of red blood cell decrease should be a practical cut-off value...
November 1, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27406646/geographic-variation-in-the-treatment-of-non-st-segment-myocardial-infarction-in-the-english-national-health-service-a-cohort-study
#10
T B Dondo, M Hall, A D Timmis, A T Yan, P D Batin, G Oliver, O A Alabas, P Norman, J E Deanfield, K Bloor, H Hemingway, C P Gale
OBJECTIVES: To investigate geographic variation in guideline-indicated treatments for non-ST-elevation myocardial infarction (NSTEMI) in the English National Health Service (NHS). DESIGN: Cohort study using registry data from the Myocardial Ischaemia National Audit Project. SETTING: All Clinical Commissioning Groups (CCGs) (n=211) in the English NHS. PARTICIPANTS: 357 228 patients with NSTEMI between 1 January 2003 and 30 June 2013...
July 12, 2016: BMJ Open
https://www.readbyqxmd.com/read/27366972/coronary-ct-angiography-in-clinical-triage-of-patients-at-high-risk-of-coronary-artery-disease
#11
J Tobias Kühl, Jens D Hove, Thomas S Kristensen, Jakob B Norsk, Thomas Engstrøm, Lars Køber, Henning Kelbæk, Klaus F Kofoed
OBJECTIVES: To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. DESIGN: The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed...
August 9, 2016: Scandinavian Cardiovascular Journal: SCJ
https://www.readbyqxmd.com/read/27352863/atherothrombotic-non-st-segment-elevation-myocardial-infarction-in-a-42-year-old-white-female-with-no-known-cardiovascular-risk-factors
#12
William Marshall
Coronary artery disease (CAD) in the absence of known cardiovascular risk factors is rare. This is the case report of a 42-year-old white female who was admitted with a non-ST segment elevation myocardial infarction (NSTEMI). The patient had seen her general practitioner (GP) in the 2 weeks prior to this with exertional chest pain. She had no known risk factors for cardiovascular disease and other possible underlying aetiologies were ruled out. The patient underwent percutaneous coronary intervention (PCI) to the culprit lesion in the left anterior descending artery...
2016: BMJ Case Reports
https://www.readbyqxmd.com/read/27328951/angiographic-findings-and-revascularization-success-in-patients-with-acute-myocardial-infarction-and-previous-coronary-bypass-grafting
#13
Florian Blachutzik, Stephan Achenbach, Monique Troebs, Jens Roether, Holger Nef, Christian Hamm, Christian Schlundt
Current guidelines recommend invasive coronary angiography and interventional revascularization in ST-elevation and Non-ST-elevation myocardial infarction (STEMI and NSTEMI). The aim of this study was to analyze culprit lesions and percutaneous coronary intervention (PCI) success in patients with previous coronary artery bypass grafting (CABG). We analyzed the data of 121 consecutive patients in whom coronary angiography was performed in the setting of STEMI or NSTEMI and who had previous CABG. Coronary angiograms were reviewed, and clinical data were evaluated...
August 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/27256475/clinical-management-and-hospital-outcomes-of-acute-coronary-syndrome-patients-in-mexico-the-third-national-registry-of-acute-coronary-syndromes-renasica-iii
#14
Carlos Martinez-Sanchez, Gabriela Borrayo, Jorge Carrillo, Ursulo Juarez, Juan Quintanilla, Carlos Jerjes-Sanchez
OBJECTIVE: To describe current management and clinical outcomes in patients hospitalized with an acute coronary syndrome (ACS) in Mexico. METHODS: RENASICA III was a prospective multicenter registry of consecutive patients hospitalized with an ACS. Patients had objective evidence of ischemic heart disease; those with type II infarction or secondary ischemic were excluded. Study design conformed to current quality recommendations. RESULTS: A total of 123 investigators at 29 tertiary and 44 community hospitals enrolled 8296 patients with an ACS (4038 with non-ST-elevation myocardial infarction/unstable angina [NSTEMI/UA], 4258 with ST-elevation myocardial infarction [STEMI])...
July 2016: Archivos de Cardiología de México
https://www.readbyqxmd.com/read/27193907/on-versus-off-hour-care-for-patients-with-non-st-segment-elevation-myocardial-infarction-in-germany-exemplary-results-within-the-chest-pain-unit-concept
#15
F Breuckmann, F Remberg, D Böse, J Waltenberger, D Fischer, T Rassaf
AIM: The aim of this study was to analyze differences in the timing of invasive management of patients with high-risk acute coronary syndrome without persistent ST-segment elevation (hr-NSTE-ACS) or myocardial infarction without persistent ST-segment elevation (NSTEMI) between on- and off-hours in a German chest pain unit (CPU). PATIENTS AND METHODS: We retrospectively enrolled 160 NSTEMI patients in the study, who were admitted to two German CPUs in 2013. Patients presenting on weekdays between 8 a...
December 2016: Herz
https://www.readbyqxmd.com/read/27154526/acute-versus-subacute-angiography-in-patients-with-non-st-elevation-myocardial-infarction-the-nonstemi-trial-phase-i
#16
Carsten Stengaard, Jacob T Sørensen, Martin B Rasmussen, Hanne M Søndergaard, Karen K Dodt, Troels Niemann, Lars Frost, Tage Jensen, Troels M Hansen, Ingunn Skogstad Riddervold, Claus-Henrik Rasmussen, Mathias Giebner, Jens Aarøe, Michael Maeng, Evald H Christiansen, Steen D Kristensen, Hans E Bøtker, Christian J Terkelsen
BACKGROUND: The 2015 European Society of Cardiology non-ST-elevation myocardial infarction (NSTEMI) guidelines recommend angiography within 24 h in high-risk patients with NSTEMI. An organized STEMI-like approach with pre-hospital or immediate in-hospital triage for acute coronary angiography (CAG) may be of therapeutic benefit but it remains unknown whether the patients can be properly diagnosed in the pre-hospital setting. We aim to evaluate whether it is feasible to diagnose patients with NSTEMI in the pre-hospital phase or immediately upon admission...
May 6, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27142174/excess-mortality-and-guideline-indicated-care-following-non-st-elevation-myocardial-infarction
#17
Tatendashe B Dondo, Marlous Hall, Adam D Timmis, Mark S Gilthorpe, Oras A Alabas, Phillip D Batin, John E Deanfield, Harry Hemingway, Chris P Gale
BACKGROUND: Adherence to guideline-indicated care for the treatment of non-ST-elevation myocardial infarction (NSTEMI) is associated with improved outcomes. We investigated the extent and consequences of non-adherence to guideline-indicated care across a national health system. METHODS: A cohort study (ClinicalTrials.gov identifier: NCT02436187) was conducted using data from the Myocardial Ischaemia National Audit Project (n = 389,057 NSTEMI, n = 247 hospitals, England and Wales, 2003-2013)...
May 3, 2016: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/27133325/clinical-profile-and-30-day-outcome-of-women-with-acute-coronary-syndrome-as-a-first-manifestation-of-ischemic-heart-disease-a-single-center-observational-study
#18
Veena Nanjappa, Gopi Aniyathodiyil, R Keshava
BACKGROUND: Gender disparity, with respect to women receiving less medical therapy, undergoing fewer invasive procedures, and experiencing worse outcome than men, has been noted in various observational and randomized trials, though guidelines on acute coronary syndrome (ACS) are gender-neutral. Indian data with focus on women with ACS are lacking. AIM: This study was undertaken to give us an insight on the clinical presentation, risk factors, and in-hospital outcome of ACS in women and at 30 days...
March 2016: Indian Heart Journal
https://www.readbyqxmd.com/read/27132878/gender-difference-in-the-use-of-coronary-interventions-for-patients-with-acute-coronary-syndrome-experience-from-a-major-metropolitan-hospital-in-melbourne-australia
#19
Linda Worrall-Carter, Andrew MacIsaac, Elizabeth Scruth, Muhammad Aziz Rahman
BACKGROUND: Literature suggests an ongoing gender disparity in the use of coronary angiography and subsequent interventions among patients with acute coronary syndrome (ACS). OBJECTIVES: The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome (ACS) admitted to a major metropolitan hospital in Melbourne during the period 2009-2012. METHODS: We undertook a retrospective analysis of a hospital database of 2096 ACS patients...
April 25, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/27081653/coronary-artery-aneurysmal-disease-and-acute-coronary-syndrome
#20
Wesam Ostwani, Holly Fleming, Carlos A Roldan
The patient is a 70-year-old male with no other atherogenic risk factors who presented with an acute coronary syndrome (ACS) of unstable angina subsequently complicated by a non-ST elevation myocardial infarction (NSTEMI). The patient's presentation posed 3 unique features: (1) cardiac catheterization demonstrated nonobstructive 3-vessel multi-aneurysmal coronary artery disease with sluggish antegrade coronary flow; (2) a nonobstructive aneurysmal dissection flap based on contrast staining of the mid left anterior descending artery, which may have led to in situ nonocclusive thrombosis and distal microvascular embolization; and (3) successful conservative medical therapy of coronary artery aneurysmal disease (CAAD) complicated with ACS...
January 2016: Journal of Investigative Medicine High Impact Case Reports
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