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NSTEMI GUIDELINES

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https://www.readbyqxmd.com/read/29657032/referral-for-cardiac-rehabilitation-after-acute-myocardial-infarction-insights-from-nationwide-amis-plus-registry-2005-2017
#1
Matthias Hermann, Fabienne Witassek, Paul Erne, Dragana Radovanovic, Hans Rickli
BACKGROUND: Referral rates for cardiac rehabilitation (CR) after an acute myocardial infarction (AMI) are low despite a Class I recommendation in the present guidelines. Therefore, we aimed to identify predictors for referral and patient characteristics from the national Swiss AMIS Plus registry. DESIGN AND METHODS: Data were extracted from the Swiss AMIS Plus registry between 2005 and 2017, which included patients with ST-elevation myocardial infarction (STEMI) and Non-ST-elevation myocardial infarction (NSTEMI)...
June 15, 2018: International Journal of Cardiology
https://www.readbyqxmd.com/read/29588304/inhibitory-mechanisms-of-very-low-dose-rivaroxaban-in-non-st-elevation-myocardial-infarction
#2
Oliver Borst, Patrick Münzer, Nada Alnaggar, Sascha Geue, Roland Tegtmeyer, Dominik Rath, Michal Droppa, Peter Seizer, Stefan Heitmeier, Johan W M Heemskerk, Lisa K Jennings, Robert F Storey, Dominick J Angiolillo, Bianca Rocca, Henri Spronk, Hugo Ten Cate, Meinrad Gawaz, Tobias Geisler
Very low-dose (VLD) factor Xa (FXa) inhibition, in combination with acetylsalicylic acid (ASA) and clopidogrel, is associated with improved outcomes in patients with acute coronary syndrome (ACS) with a tolerable bleeding risk profile. To date, there are no data documenting platelet inhibition and the anticoagulatory effects of VLD FXa inhibition on top of guideline-adherent dual-antiplatelet therapy (DAPT) in patients with ACS. Patients with non-ST-elevation myocardial infarction (NSTEMI) receiving oral DAPT (ASA + clopidogrel, n = 20; or ASA + ticagrelor, n = 20) were prospectively enrolled in a nonrandomized study...
March 27, 2018: Blood Advances
https://www.readbyqxmd.com/read/29548521/the-utility-of-the-triage-electrocardiogram-for-the-detection-of-st-segment-elevation-myocardial-infarction
#3
Samantha Noll, Heidi Alvey, Namita Jayaprakash, Aniruddha Paranjpe, Joseph Miller, Michele L Moyer, Richard Nowak
INTRODUCTION: Current AHA/ACC guidelines on the management of ST-elevation myocardial infarction (STEMI) suggest that an ECG is indicated within 10minutes of arrival for patients arriving to the Emergency Department (ED) with symptoms concerning for STEMI. In response, there has been a creep towards performing ECGs more frequently in triage. The objectives of this study were to quantify the number of triage ECGs performed at our institution, assess the proportion of ECGs performed within current hospital guidelines, and evaluate the rate of STEMI detection in triage ECGs...
February 3, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29543035/guideline-adherence-regarding-critical-time-intervals-in-the-german-chest-pain-unit-registry
#4
Mehrshad Vafaie, Matthias Hochadel, Thomas Münzel, Birgit Hailer, Burghard Schumacher, Gerd Heusch, Thomas Voigtländer, Harald Mudra, Michael Haude, Sebastian Barth, Claus Schmitt, Harald Darius, Lars S Maier, Hugo A Katus, Jochen Senges, Evangelos Giannitsis
BACKGROUND: Since 2008, the German Cardiac Society certified 256 Chest Pain Units (CPUs). Little is known about adherence to recommended performance measures in patients with suspected acute coronary syndrome (ACS) presenting to CPUs. We investigated guideline-adherence regarding critical time intervals and selected performance measures in German Chest Pain Units. METHODS: From 2008 to 2014, 23,804 consecutive patients with suspected ACS were prospectively enrolled in the Chest Pain Unit registry of the German Cardiac Society...
March 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29525779/non-st-segment-elevation-myocardial-infarction-among-patients-with-chronic-kidney-disease-a-propensity-score-matched-comparison-of-percutaneous-coronary-intervention-versus-conservative-management
#5
Subir Bhatia, Shilpkumar Arora, Sravya M Bhatia, Mohammed Al-Hijji, Yogesh N V Reddy, Parshva Patel, Charanjit S Rihal, Bernard J Gersh, Abhishek Deshmukh
BACKGROUND: Chronic kidney disease (CKD) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention (PCI) in non-ST-segment-elevation myocardial infarction (NSTEMI) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients. METHODS AND RESULTS: Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in-hospital outcomes in NSTEMI admissions with CKD...
March 10, 2018: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29525724/invasive-versus-conservative-strategy-in-frail-patients-with-nstemi-the-mosca-frail-clinical-trial-study-design
#6
Juan Sanchis, Albert Ariza-Solé, Emad Abu-Assi, Oriol Alegre, Fernando Alfonso, José Antonio Barrabés, José Antonio Baz, Antonio Carol, Pablo Díez Villanueva, Bruno García Del Blanco, Jaime Elízaga, Eduard Fernandez, Abel García Del Egido, Joan García Picard, Iván Gómez Blázquez, Joan Antoni Gómez Hospital, Rosana Hernández-Antolín, Cinta Llibre, Francisco Marín, David Martí Sánchez, Roberto Martín, Manuel Martínez Sellés, Gema Miñana, María José Morales Gallardo, Julio Núñez, Armando Pérez de Prado, Eduardo Pinar, Marcelo Sanmartín, Alessandro Sionis, Adolfo Villa, Jaume Marrugat, Héctor Bueno
INTRODUCTION AND OBJECTIVES: Although clinical guidelines recommend invasive management in non-ST-segment elevation myocardial infarction (NSTEMI), this strategy is underused in frail elderly patients in the real world. Furthermore, these patients are underrepresented in clinical trials and therefore the evidence is scarce. Our hypothesis is that an invasive strategy will improve prognosis in elderly frail patients with NSTEMI. METHODS: This will be a prospective, multicenter, randomized trial, in which the conservative and invasive strategies will be compared in patients meeting all of the following inclusion criteria: NSTEMI diagnosis, age ≥ 70 years, and frailty defined by a category ≥ 4 in the Clinical Frailty Scale...
March 7, 2018: Revista Española de Cardiología
https://www.readbyqxmd.com/read/29471951/contemporary-patterns-of-early-coronary-angiography-use-in-patients-with-non-st-segment-elevation-myocardial-infarction-in-the-united-states-insights-from-the-national-cardiovascular-data-registry-acute-coronary-treatment-and-intervention-outcomes-network-registry
#7
Carolina Malta Hansen, Tracy Y Wang, Anita Y Chen, Karen Chiswell, Deepak L Bhatt, Jonathan R Enriquez, Timothy Henry, Matthew T Roe
OBJECTIVES: The study sought to characterize patient- and hospital-level variation in early angiography use among non-ST-segment elevation myocardial infarction (NSTEMI) patients. BACKGROUND: Contemporary implementation of guideline recommendations for early angiography use in NSTEMI patients in the United States have not been described. METHODS: The study analyzed NSTEMI patients included in ACTION (Acute Coronary Treatment and Intervention Outcomes Network) registry (2012 to 2014) who underwent in-hospital angiography...
February 26, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29421016/rationale-and-design-of-the-dear-old-trial-randomized-evaluation-of-routinely-deferred-versus-early-invasive-strategy-in-elderly-patients-of-75-years-or-older-with-non-st-elevation-myocardial-infarction
#8
Wen-Xiu Leng, Jingang Yang, Wei Li, Yang Wang, Yue-Jin Yang
BACKGROUND: Comparing with conservative strategy, early invasive approach has been shown to be beneficial for initially stabilized patients with non-ST-elevation myocardial infarction (NSTEMI). However, concerns of increased risk of bleeding and other complications associated with early revascularization in patients aged ≥75 years persist. A routinely deferred invasive strategy aiming to facilitate revascularization after stabilizing the culprit lesion predominates across China. AIM: The aim was to compare efficacy and safety of deferred invasive strategy versus guideline-recommended early invasive strategy in initially stabilized Chinese patients aged ≥75 years with NSTEMI...
February 2018: American Heart Journal
https://www.readbyqxmd.com/read/29073657/is-cardiomegaly-on-chest-radiograph-representative-of-true-cardiomegaly-a-cross-sectional-observational-study-comparing-cardiac-size-on-chest-radiograph-to-that-on-echocardiography
#9
COMPARATIVE STUDY
Jane L McKee, Katherine Ferrier
AIMS: To determine whether or not cardiomegaly identified on chest radiograph (CXR) is indicative of true cardiomegaly as determined using echocardiography (echo) as the gold standard tool, and therefore whether or not cardiomegaly on CXR should be investigated further. METHODS: CXR and echocardiogram reports were reviewed for the presence of cardiomegaly in a population following non-ST segment elevation myocardial infarction (NSTEMI). Data was evaluated to determine whether cardiomegaly reported on CXR did indeed represent true cardiomegaly...
October 27, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/29072379/-early-rather-than-immediate-pci-in-nstemi-is-time-equal-to-muscle-once-again
#10
Shemy Carasso, Ali Nassar, Fabio Kuzniec, Yevgeni Hazanov, Nabeeh Salman, Yussra Halhla, Offer Amir, Diab Ghanem
BACKGROUND: Current guidelines advocate immediate vs. non-immediate percutaneous coronary intervention (PCI) strategy in ST elevation vs. non ST elevation myocardial infarction (STEMI, NSTEMI). There is however increasing concern that "next-day PCI" in NSTEMI may adversely affect LV systolic and/or diastolic function and a more urgent aggressive approach should be taken in NSTEMI, similar to that in STEMI. In the current study we compared echocardiographic data between patients with STEMI and NSTEMI who had either primary or early PCI respectively...
October 2017: Harefuah
https://www.readbyqxmd.com/read/29054840/contemporary-risk-stratification-after-myocardial-infarction-in-the-community-performance-of-scores-and-incremental-value-of-soluble-suppression-of-tumorigenicity-2
#11
Yariv Gerber, Susan A Weston, Maurice Enriquez-Sarano, Allan S Jaffe, Sheila M Manemann, Ruoxiang Jiang, Véronique L Roger
BACKGROUND: Current American Heart Association/American College of Cardiology guidelines recommend the GRACE (Global Registry of Acute Coronary Events) and TIMI (Thrombolysis in Myocardial Infarction) scores to assess myocardial infarction (MI) prognosis. Changes in the epidemiological characteristics of MI and the availability of new biomarkers warrant an assessment of the performance of these scores in contemporary practice. We assessed the following: (1) the performance of GRACE and TIMI to predict 1-year mortality in a cohort of patients stratified by ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) and (2) the incremental discriminatory power of soluble suppression of tumorigenicity-2, a myocardial fibrosis biomarker...
October 20, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29035427/differences-in-the-korea-acute-myocardial-infarction-registry-compared-with-western-registries
#12
REVIEW
Doo Sun Sim, Myung Ho Jeong
The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglyceride and lower high-density lipoprotein cholesterol levels...
November 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28958142/serum-25-hydroxy-vitamin-d-concentration-in-acute-coronary-syndrome
#13
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/28942868/gender-differences-in-the-management-of-acute-coronary-syndrome-patients-one-year-results-from-hpiar-hp-india-acs-registry
#14
Kunal Mahajan, Prakash Chand Negi, Rajeev Merwaha, Nitin Mahajan, Vivek Chauhan, Sanjeev Asotra
INTRODUCTION: Data from high-income countries suggest that women receive less intensive diagnostic and therapeutic management than men for acute coronary syndrome (ACS). There is a paucity of such data in the Indian population, which is 69% rural and prior studies focused mostly on urban populations. The objective of the present study was to identify the gender based differences in ACS management, if any, in a predominantly rural population. METHODS: Data from 35 hospitals across Himachal Pradesh covering >90% of state population were collected for one year (July 2015-June 2016)...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28893843/timing-of-angiography-and-outcomes-in-high-risk-patients-with-non-st-segment-elevation-myocardial-infarction-managed-invasively-insights-from-the-tao-trial-treatment-of-acute-coronary-syndrome-with-otamixaban
#15
RANDOMIZED CONTROLLED TRIAL
Pierre Deharo, Gregory Ducrocq, Christoph Bode, Marc Cohen, Thomas Cuisset, Shamir R Mehta, Charles Pollack, Stephen D Wiviott, Yedid Elbez, Marc S Sabatine, Philippe Gabriel Steg
BACKGROUND: In patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and GRACE (Global Registry of Acute Coronary Events) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24 hours. We sought to study the association of very early (ie, ≤12 hours), early (12-24 hours), and delayed (>24 hours) CAG in patients with NSTEMI with GRACE score >140 with ischemic outcomes. METHODS: The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with NSTEMI and CAG scheduled within 72 hours to heparin plus eptifibatide versus otamixaban...
November 14, 2017: Circulation
https://www.readbyqxmd.com/read/28868075/determinants-of-invasive-strategy-in-elderly-patients-with-non-st-elevation-myocardial-infarction
#16
Antonin Negers, Jacques Boddaert, Lucie Mora, Jean-Louis Golmard, Laura Moïsi, Ariel Cohen, Jean-Philippe Collet, Alice Breining
BACKGROUND: Knowledge gaps across literature prevent current guidelines from providing the profile of elderly patients most likely to derive benefit from invasive strategy (IS) in non ST-elevation myocardial infarction (NSTEMI). Furthermore, the benefit of IS in a real-world elderly population with NSTEMI remains unclear. The aims of this study were to determine factors that lead the cardiologist to opt for an IS in elderly patients with NSTEMI, and to assess the impact of IS on the 6-month all-cause mortality...
July 2017: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/28660806/antiplatelet-therapy-for-non-st-segment-elevation-myocardial-infarction-in-complex-real-clinical-scenarios-a-consensus-document-of-the-campania-nstemi-study-group
#17
Marino Scherillo, Plinio Cirillo, Dario Formigli, Giulio Bonzani, Paolo Calabrò, Paolo Capogrosso, Rosario Farina, Tonino Lanzillo, Franco Mascia, Ciro Mauro, Bernardino Tuccillo, Alessandro Bellis, Renato Bianchi, Giovanni Cimmino, Orlando Piro, Amelia Ravera, Fortunato Scotto di Uccio, Paolo Tammaro, Alfredo Vetrano, Bruno Trimarco
The incidence of ST-segment elevation myocardial infarction (STEMI) has significantly decreased. Conversely, the rate of non-STEMI (NSTEMI) has increased. Patients with NSTEMI have lower short-term mortality compared to patients with STEMI, whereas at long-term follow-up, the mortality becomes comparable. This might be due to the differences in baseline characteristics, including older age and a greater prevalence of comorbidities in the NSTEMI population. Although antithrombotic strategies used in patients with NSTEMI have been well studied in clinical trials and updated guidelines are available, patterns of use and outcomes in clinical practice are less well described...
August 2017: Angiology
https://www.readbyqxmd.com/read/28625385/seasonal-and-circadian-variations-of-acute-myocardial-infarction-findings-from-the-get-with-the-guidelines-coronary-artery-disease-gwtg-cad-program
#18
MULTICENTER STUDY
Vijaiganesh Nagarajan, Gregg C Fonarow, Christine Ju, Michael Pencina, Warren K Laskey, Thomas M Maddox, Adrian Hernandez, Deepak L Bhatt
BACKGROUND: Seasonal variation with winter preponderance of myocardial infarction incidence has been described decades ago, but only a few small studies have classified myocardial infarction based on ST-segment elevation. It is unclear whether seasonal and circadian variations are equally present in warmer and colder regions. We investigated whether seasonal and circadian variations in acute myocardial infarction (AMI) are more prominent in colder northern states compared with warmer southern states...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28498644/early-versus-late-percutaneous-revascularization-in-patients-hospitalized-with-non-st-segment-elevation-myocardial-infarction-the-atherosclerosis-risk-in-communities-surveillance-study
#19
Sameer Arora, Kunihiro Matsushita, Arman Qamar, R Brandon Stacey, Melissa C Caughey
BACKGROUND: Current guidelines recommend early invasive intervention (<24 hr) for high risk patients with non-ST-segment elevation myocardial infarction (NSTEMI). A delayed invasive strategy (24-72 hr) is considered reasonable for low risk patients. The real-world effectiveness of this strategy is unknown. METHODS: The ARIC Study has conducted hospital surveillance of acute myocardial infarction (MI) since 1987. NSTEMI was classified using a validated algorithm...
May 12, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28454811/compliance-with-guideline-directed-therapy-in-diabetic-patients-admitted-with-acute-coronary-syndrome-findings-from-the-american-heart-association-s-get-with-the-guidelines-coronary-artery-disease-gwtg-cad-program
#20
Prakash Deedwania, Tushar Acharya, Kamal Kotak, Gregg C Fonarow, Christopher P Cannon, Warren K Laskey, W Frank Peacock, Wenqin Pan, Deepak L Bhatt
BACKGROUND: To evaluate and compare baseline characteristics, outcomes and compliance with guideline based therapy at discharge among diabetic and non-diabetic patients admitted with acute coronary syndromes (ACS). METHODS AND RESULTS: Study population consisted of 151,270 patients admitted with ACS from 2002 through 2008 at 411 sites participating in the American Heart Association's Get with the Guidelines (GWTG) program. Demographic variables, physical exam findings, laboratory data, left ventricular ejection fraction, length of stay, in-hospital mortality and discharge medications were compared between diabetic and non-diabetic patients...
May 2017: American Heart Journal
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