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coronary artery disease guidelines

Satoko Noguchi, Junichi Saito, Tomoyuki Kudo, Eiji Hashiba, Kazuyoshi Hirota
Background: We have reviewed four cases of Kawasaki disease treated with plasma exchange with 5% albumin in electrolyte-balanced solution, according to the recommended guidelines for Kawasaki disease in the intensive care unit, as their responses to intravenous immunoglobulin therapy were poor. Case presentation: The four cases were aged between 5 months and 3 years and weighted between 6.4 and 15.6 kg. The plasma levels of C-reactive protein were significantly decreased after plasma exchange ( p  < 0...
2018: JA Clin Rep
Wilbert S Aronow, William H Frishman
The 2017 American College of Cardiology/American Heart Association hypertension guidelines diagnose hypertension if systolic blood pressure (SBP) is ≥ 130 mmHg or diastolic blood pressure (DBP) is ≥ 80 mmHg. Increased BP is SBP 120-129 mmHg with DBP < 80 mmHg. Lifestyle measures should be used to treat individuals with increased BP. Lifestyle measures plus BP-lowering drugs should be used for secondary prevention of recurrent cardiovascular events in individuals with clinical cardiovascular disease (coronary heart disease, congestive heart failure, or stroke) and an average SBP ≥ 130 mmHg or an average DBP ≥ 80 mmHg...
March 13, 2018: Drugs
David R Dobies, Kimberly R Barber
Evidence-based medicine (EBM) provides clinicians with beneficial information. Nonetheless, study findings are often arbitrary, speculative or provisional. The current state of misleading evidence exists in all applications, including those for guideline recommendations. We conductedan appraisal of the American College of Cardiologyand European Society of Cardiology Guidelines for revascularisation of complex coronary anatomy to determine the veracity of the evidence that recommendations were based on. Study-specific critical appraisals were conducted by the authors on the 5-year Synergy between percutaneous coronary intervention with Taxus and cardiac surgery (SYNTAX) and future revascularisation evaluation in patients with diabetes mellitus: optimal management of multivessel disease (FREEDOM) Trials...
2018: Open Heart
Mohammad A Hossain, Amy Quinlan, Jennifer Heck-Kanellidis, Dawn Calderon, Tejas Patel, Bhavika Gandhi, Shrinil Patel, Mahida Hetavi, Eric J Costanzo, James Cosentino, Chirag Patel, Asa Dewan, Yen-Hong Kuo, Loay Salman, Tushar J Vachharajani
BACKGROUND: While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. METHODS: In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery...
March 1, 2018: Journal of Vascular Access
Jacob A Udell, Gregg C Fonarow, Thomas M Maddox, Christopher P Cannon, W Frank Peacock, Warren K Laskey, Maria V Grau-Sepulveda, Eric E Smith, Adrian F Hernandez, Eric D Peterson, Deepak L Bhatt
BACKGROUND: Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. Hypothesis Age is a modifier of temporal trends in sex-based differences in ACS care. METHODS: Among 104,817 eligible patients with ACS enrolled in the AHA GWTG-CAD registry between 2003-2008, care and in-hospital mortality were evaluated stratified by sex and age (<65 years and ≥65 years). Temporal trends within sex and age groups were assessed for two care processes: the percentage of patients with ST-elevation MI (STEMI) presenting to PCI capable hospitals with a door-to-balloon time ≤ 90 minutes (DTB90) and the proportion of eligible patients with ACS treated with aspirin within 24 hours of presentation...
March 9, 2018: Clinical Cardiology
Petar M Seferović, Mark C Petrie, Gerasimos S Filippatos, Stefan D Anker, Giuseppe Rosano, Johann Bauersachs, Walter J Paulus, Michel Komajda, Francesco Cosentino, Rudolf A de Boer, Dimitrios Farmakis, Wolfram Doehner, Ekaterini Lambrinou, Yuri Lopatin, Massimo F Piepoli, Michael J Theodorakis, Henrik Wiggers, John Lekakis, Alexandre Mebazaa, Mamas A Mamas, Carsten Tschöpe, Arno W Hoes, Jelena P Seferović, Jennifer Logue, Theresa McDonagh, Jillian P Riley, Ivan Milinković, Marija Polovina, Dirk J van Veldhuisen, Mitja Lainscak, Aldo P Maggioni, Frank Ruschitzka, John J V McMurray
The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice...
March 8, 2018: European Journal of Heart Failure
Amartya Kundu, Aditya Vaze, Partha Sardar, Ahmed Nagy, Wilbert S Aronow, Naomi F Botkin
PURPOSE OF REVIEW: Variant angina, which is characterized by recurrent chest pain and transient ECG changes along with angiographic evidence of coronary artery spasm, generally has a favorable prognosis. However, episodes of ischemia caused by vasospasm may lead to potentially life-threatening ventricular arrhythmias and cardiac arrest, even in patients with no history of prior cardiac disease. This review describes the epidemiology, pathogenesis, clinical spectrum, and management of variant angina, as well as outcomes in patients who present with aborted sudden cardiac death (ASCD)...
March 8, 2018: Current Cardiology Reports
AbdulWahab Hritani, M Fuad Jan, Gregory Schleis, Tara Zehrer, Susan Olet, Khawaja Afzal Ammar, Suhail Allaqaband
BACKGROUND: After the introduction of the universal definition of myocardial infarction, the incidence and diagnosis of type 2 myocardial infarction have risen dramatically, yet there are no clear guidelines on clinical management. Diabetic patients are at high risk for developing type 2 myocardial infarction when admitted in a decompensated state and they are also at high risk for future cardiovascular events. METHODS: We performed a retrospective analysis of 1058 patients between 2011 and 2016 admitted with diabetic ketoacidosis or hyperosmolar hyperglycemic state...
March 5, 2018: American Journal of Medicine
Allison D Ta, Li-Yueh Hsu, Hannah M Conn, Susanne Winkler, Anders M Greve, Sujata M Shanbhag, Marcus Y Chen, W Patricia Bandettini, Andrew E Arai
BACKGROUND: Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion. METHODS: Regadenoson perfusion CMR was performed at 1.5 T in 76 patients. Significant CAD was defined by quantitative invasive coronary angiography (QCA) ≥ 50% diameter stenosis...
March 8, 2018: Journal of Cardiovascular Magnetic Resonance
Thomas Krysztofiak, John Byrne
High-sensitivity cardiac troponin assays have emerged as a powerful tool in the management of patients presenting acutely to hospital with suspected cardiac chest pain. Recent guidelines emphasize the reassurance offered by low troponin concentrations early after admission. We describe a patient with known coronary artery disease, who presented with a classical history of recurrent myocardial ischaemia. High-sensitivity cardiac Troponin-I concentrations remained in the low-normal sex-specific reference range, despite serial testing on the day of admission, and despite recurrent pain with dynamic ECG changes...
January 1, 2018: Scottish Medical Journal
Marcello Arca, David Ansell, Maurizio Averna, Francesca Fanelli, Katherine Gorcyca, Şerban R Iorga, Aldo P Maggioni, Georges Paizis, Radovan Tomic, Alberico L Catapano
BACKGROUND AND AIMS: Statin utilization and lipid goal achievement were estimated in a large sample of Italian patients at high/very-high cardiovascular (CV) risk. METHODS: Patients aged ≥18 years with a valid low-density lipoprotein cholesterol (LDL-C) measurement in 2015 were selected from the IMS Health Real World Data database; non-high-density lipoprotein cholesterol (non-HDL-C) was assessed in those with available total cholesterol measurements. Index dates were defined as the last valid lipid measurement in 2015...
February 17, 2018: Atherosclerosis
Roosevelt Bryant, David Morales
Transplantation for adult patients with congenital heart disease (ACHD) is a growing clinical endeavor in the transplant community. Understanding the results and defining potential high-risk patient subsets will allow optimization of patient outcomes. This review summarizes the scope of ACHD transplantation, the mechanisms of late ventricular dysfunction, the ACHD population at risk of developing heart failure, the indications and potential contraindications for transplant, surgical considerations, and post-transplant outcomes...
January 2018: Annals of Cardiothoracic Surgery
Michael Shechter, Ofer Amir, Amir Lerman, Joseph Shemesh, Elad Maor, Ronen Rubinshtein
Prediction of cardiovascular adverse events is challenging. It became apparent that traditional coronary artery disease (CAD) risk factors are the cornerstones of the European 10-year CAD risk SCRORE and the Framingham score. However, despite their importance, the prediction value of general assessment tools such as the SCORE and Framingham options in an individual subject is limited, especially in young adults and women. The trend toward personalized medicine and individualized risk assessment during recent years is growing strong and various functional and imaging screening tests, including endothelial function studies, have been suggested to improve accuracy and provide the functional implications of these risk factors...
February 2018: Harefuah
George Renchao Wu, Aman Saini, Imtiaz Ahmed, Charles Finch
Anomalous coronary artery from the opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, and sudden cardiac death. Management of anomalous coronary artery from the opposite sinus varies; however, current guidelines suggest surgery in symptomatic patients. Our patient is a middle-aged male with a history of coronary artery disease and status post coronary artery bypass graft. He presented with complaints of vague chest pain. After a positive stress test, he was sent to the catheterization suite...
December 2017: Radiology case reports
Shuang Liang, Wen-Ling Wang, Fang-Lei Zhu, Shu-Wei Duan, Xue-Feng Sun, Xiang-Mei Chen, Guang-Yan Cai
INTRODUCTION: The proportion of elderly people is steadily rising worldwide, especially in low-income and middle-income countries, including China. Chronic kidney disease (CKD) is a common disorder in older people. However, little is known about the epidemiology of CKD and its consequences among the elderly. Improvements on clinical guidelines and healthcare policies for this population are required. This study aims to examine the risk factors for progression of CKD among the elderly and develop models to identify subgroups who are at high risk...
February 24, 2018: BMJ Open
Shamir R Mehta, Kevin R Bainey, Warren J Cantor, Marie Lordkipanidzé, Guillaume Marquis-Gravel, Simon D Robinson, Matthew Sibbald, Derek Y So, Graham C Wong, Joseph G Abunassar, Margaret L Ackman, Alan D Bell, Raymond Cartier, James D Douketis, Patrick R Lawler, Michael S McMurtry, Jacob A Udell, Sean van Diepen, Subodh Verma, G B John Mancini, John A Cairns, Jean-François Tanguay
Antiplatelet therapy (APT) has become an important tool in the treatment and prevention of atherosclerotic events, particularly those associated with coronary artery disease. A large evidence base has evolved regarding the relationship between APT prescription in various clinical contexts and risk/benefit relationships. The Guidelines Committee of the Canadian Cardiovascular Society and Canadian Association of Interventional Cardiology publishes regular updates of its recommendations, taking into consideration the most recent clinical evidence...
March 2018: Canadian Journal of Cardiology
Jane S Titterington, Olivia Y Hung, Anita P Saraf, Nanette K Wenger
The etiologies of acute coronary syndromes (ACS) in women expand beyond the traditional paradigm of obstructive epicardial atherosclerotic disease and plaque rupture. Fundamental differences in pathobiology and presentation can partially explain the gender disparity in ACS diagnosis and management, but there is also much we do not know about the spectrum of coronary artery disease in women. Areas covered: This review seeks to explain some key differences between men and women in terms of risk factors, pathophysiology, and clinical presentations, as well as identify areas where more data are needed, focusing on women presenting with ACS but without a culprit lesion to explain their presentation...
February 23, 2018: Expert Review of Cardiovascular Therapy
Lin Jiang, Lianjun Xu, Lei Song, Zhan Gao, Jian Tian, Kai Sun, Hongwei Yu, Bo Xu, Lei Song, Jinqing Yuan
INTRODUCTION: Current guidelines recommend coronary artery bypass grafting (CABG) for patients with multivessel coronary disease and left ventricular (LV) dysfunction. However, some patients undergo percutaneous coronary intervention (PCI) or solely medical therapy (MT) in actual practice. The comparison of long-term outcomes of these three treatment strategies in real world is unclear. METHODS: A total of 699 consecutive patients in a single centre from 2004 to 2011 who had TVD and LV ejection fraction ≤40%, no prior PCI or CABG and had completed a median 6...
February 21, 2018: Journal of Interventional Cardiology
Mi-Na Kim, Jae-Min Shim, Jong-Il Choi, Seong-Mi Park, Young Hoon Kim, Wan Joo Shim
BACKGROUND: Female sex is a risk factor for thromboembolism (TE) in atrial fibrillation (AF); however, the underlying mechanisms are unclear. We postulated that left ventricular (LV) diastolic dysfunction (LVDD) could be associated with increased thromboembolic risk in women. METHODS: From a retrospective cohort, 158 patients (female : male = 79:79) with nonvalvular AF were propensity score-matched for age, presence of diabetes, hypertension, coronary artery disease, congestive heart failure, embolic history, AF type, and AF duration...
February 20, 2018: Echocardiography
S A Habib, M N Islam, M F Rahman, M Ullah, K Pasha, S N Alam, K Mohsin, N Fatema, M R Khan, S S Shakil, M N Hasan
The purpose of this study was to investigate magnitude, pattern and involvement of previously unheralded coronary artery disease in patients suffering from clinically significant peripheral artery disease of lower limbs. This cross sectional study was carried out in National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2014 to February 2015. Total 58 patients with clinically diagnosed peripheral arterial disease of lower limb undergoing angiographic evaluation. Selective CAG in addition to peripheral arteriography was performed in all the study population as per ACC/AHA guidelines for CAG (class IIa recommendation)...
January 2018: Mymensingh Medical Journal: MMJ
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