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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
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
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
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
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
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...
2016: BMJ Open
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...
July 1, 2016: Scandinavian Cardiovascular Journal: SCJ
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
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
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
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...
May 19, 2016: Herz
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
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 ( 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
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
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
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
Dieter Fischer, Friederike Remberg, Dirk Böse, Michael Lichtenberg, Philipp Kümpers, Pia Lebiedz, Hermann-Joseph Pavenstädt, Johannes Waltenberger, Frank Breuckmann
AIM: To analyse the timing of cardiac troponin (cTn) measurements in high-risk and cTn-positive acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS) in two structurally different German chest pain units (CPUs), contrasting an urban university maximum care and a rural regional primary care facility. METHODS: All patients encoded as NSTEMI during the year 2013 were retrospectively enrolled in two centres: site (I)--centre of maximum care in an urban university setting and site (II)--centre of primary care in a rural regional care setting...
2016: European Journal of Medical Research
Ming-Jer Hsieh, Cheng-Hung Lee, Chun-Chi Chen, Shang-Hung Chang, Chao-Yung Wang, I-Chang Hsieh
BACKGROUND: Predictive value of the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs or alcohol use (HAS-BLED) score for clinical outcomes has been investigated in patients with and without atrial fibrillation. Many factors in the HAS-BLED model have been reported to be prognostic predictors in patients with post-myocardial infarction (MI). However, few studies have investigated the predictive value of HAS-BLED score on long-term survival in patients with post-MI...
March 4, 2016: Journal of Cardiology
Florian von Knobelsdorff-Brenkenhoff, Jeanette Schulz-Menger
BACKGROUND: Despite common enthusiasm for cardiovascular magnetic resonance (CMR), its application in Europe is quite diverse. Restrictions are attributed to a number of factors, like limited access, deficits in training, and incomplete reimbursement. Aim of this study is to perform a systematic summary of the representation of CMR in the guidelines of the European Society of Cardiology (ESC). METHODS: Twenty-nine ESC guidelines were screened for the terms "magnetic", "MRI", "CMR", "MR" and "imaging"...
2016: Journal of Cardiovascular Magnetic Resonance
Jackson J Liang, Erin A Fender, Yong-Mei Cha, Ryan J Lennon, Abhiram Prasad, Gregory W Barsness
Guidelines do not recommend an implantable cardioverter defibrillator (ICD) for prevention of sudden death in patients who develop ventricular arrhythmia (VA) within 48 hours of acute myocardial infarction (AMI) if they are successfully revascularized. We aimed to determine long-term survival in a cohort of early VA survivors treated with percutaneous coronary intervention (PCI) and to determine whether certain high-risk characteristics predicted worse outcomes. This retrospective study included all patients with early VA after AMI treated with PCI at our institution from 2002 to 2012 who survived to hospital discharge...
March 1, 2016: American Journal of Cardiology
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