Acute Coronary Syndrome: An episode of MYOCARDIAL ISCHEMIA that generally lasts longer than a transient anginal episode that ultimately may lead to MYOCARDIAL INFARCTION.Syndrome: A characteristic symptom complex.Angina, Unstable: Precordial pain at rest, which may precede a MYOCARDIAL INFARCTION.Coronary Angiography: Radiography of the vascular system of the heart muscle after injection of a contrast medium.Myocardial Infarction: NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).Coronary Vessels: The veins and arteries of the HEART.Coronary Artery Disease: Pathological processes of CORONARY ARTERIES that may derive from a congenital abnormality, atherosclerotic, or non-atherosclerotic cause.Platelet Aggregation Inhibitors: Drugs or agents which antagonize or impair any mechanism leading to blood platelet aggregation, whether during the phases of activation and shape change or following the dense-granule release reaction and stimulation of the prostaglandin-thromboxane system.Angioplasty, Balloon, Coronary: Dilation of an occluded coronary artery (or arteries) by means of a balloon catheter to restore myocardial blood supply.Coronary Disease: An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels.Acute Disease: Disease having a short and relatively severe course.Ticlopidine: An effective inhibitor of platelet aggregation commonly used in the placement of STENTS in CORONARY ARTERIES.Coronary Thrombosis: Coagulation of blood in any of the CORONARY VESSELS. The presence of a blood clot (THROMBUS) often leads to MYOCARDIAL INFARCTION.Chest Pain: Pressure, burning, or numbness in the chest.Coronary Circulation: The circulation of blood through the CORONARY VESSELS of the HEART.Biological Markers: Measurable and quantifiable biological parameters (e.g., specific enzyme concentration, specific hormone concentration, specific gene phenotype distribution in a population, presence of biological substances) which serve as indices for health- and physiology-related assessments, such as disease risk, psychiatric disorders, environmental exposure and its effects, disease diagnosis, metabolic processes, substance abuse, pregnancy, cell line development, epidemiologic studies, etc.Hemorrhage: Bleeding or escape of blood from a vessel.Electrocardiography: Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY.Risk Factors: An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.Treatment Outcome: Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.Platelet Glycoprotein GPIIb-IIIa Complex: Platelet membrane glycoprotein complex important for platelet adhesion and aggregation. It is an integrin complex containing INTEGRIN ALPHAIIB and INTEGRIN BETA3 which recognizes the arginine-glycine-aspartic acid (RGD) sequence present on several adhesive proteins. As such, it is a receptor for FIBRINOGEN; VON WILLEBRAND FACTOR; FIBRONECTIN; VITRONECTIN; and THROMBOSPONDINS. A deficiency of GPIIb-IIIa results in GLANZMANN THROMBASTHENIA.Coronary Stenosis: Narrowing or constriction of a coronary artery.Troponin T: One of the three polypeptide chains that make up the TROPONIN complex. It is a cardiac-specific protein that binds to TROPOMYOSIN. It is released from damaged or injured heart muscle cells (MYOCYTES, CARDIAC). Defects in the gene encoding troponin T result in FAMILIAL HYPERTROPHIC CARDIOMYOPATHY.Coronary Artery Bypass: Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion.Prospective Studies: Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.Angina Pectoris: The symptom of paroxysmal pain consequent to MYOCARDIAL ISCHEMIA usually of distinctive character, location and radiation. It is thought to be provoked by a transient stressful situation during which the oxygen requirements of the MYOCARDIUM exceed that supplied by the CORONARY CIRCULATION.Percutaneous Coronary Intervention: A family of percutaneous techniques that are used to manage CORONARY OCCLUSION, including standard balloon angioplasty (PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY), the placement of intracoronary STENTS, and atheroablative technologies (e.g., ATHERECTOMY; ENDARTERECTOMY; THROMBECTOMY; PERCUTANEOUS TRANSLUMINAL LASER ANGIOPLASTY). PTCA was the dominant form of PCI, before the widespread use of stenting.Myocardial Revascularization: The restoration of blood supply to the myocardium. (From Dorland, 28th ed)Troponin I: One of the three polypeptide chains that make up the TROPONIN complex. It inhibits F-actin-myosin interactions.Risk Assessment: The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (CORONARY ARTERY DISEASE), to obstruction by a thrombus (CORONARY THROMBOSIS), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (MYOCARDIAL INFARCTION).Predictive Value of Tests: In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.Time Factors: Elements of limited time intervals, contributing to particular results or situations.Purinergic P2Y Receptor Antagonists: Compounds that bind to and block the stimulation of PURINERGIC P2Y RECEPTORS. Included under this heading are antagonists for specific P2Y receptor subtypes.Prognosis: A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.Aspirin: The prototypical analgesic used in the treatment of mild to moderate pain. It has anti-inflammatory and antipyretic properties and acts as an inhibitor of cyclooxygenase which results in the inhibition of the biosynthesis of prostaglandins. Aspirin also inhibits platelet aggregation and is used in the prevention of arterial and venous thrombosis. (From Martindale, The Extra Pharmacopoeia, 30th ed, p5)Plaque, Atherosclerotic: Lesions formed within the walls of ARTERIES.Enoxaparin: Low-molecular-weight fragment of heparin, having a 4-enopyranosuronate sodium structure at the non-reducing end of the chain. It is prepared by depolymerization of the benzylic ester of porcine mucosal heparin. Therapeutically, it is used as an antithrombotic agent. (From Merck Index, 11th ed)Creatine Kinase, MB Form: An isoenzyme of creatine kinase found in the CARDIAC MUSCLE.Follow-Up Studies: Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.Coronary Care Units: The hospital unit in which patients with acute cardiac disorders receive intensive care.Anticoagulants: Agents that prevent clotting.Ultrasonography, Interventional: The use of ultrasound to guide minimally invasive surgical procedures such as needle ASPIRATION BIOPSY; DRAINAGE; etc. Its widest application is intravascular ultrasound imaging but it is useful also in urology and intra-abdominal conditions.C-Reactive Protein: A plasma protein that circulates in increased amounts during inflammation and after tissue damage.Coronary Vasospasm: Spasm of the large- or medium-sized coronary arteries.Heptanoic Acids: 7-carbon saturated monocarboxylic acids.Troponin: One of the minor protein components of skeletal muscle. Its function is to serve as the calcium-binding component in the troponin-tropomyosin B-actin-myosin complex by conferring calcium sensitivity to the cross-linked actin and myosin filaments.Stents: Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting.Fibrinolytic Agents: Fibrinolysin or agents that convert plasminogen to FIBRINOLYSIN.Angina, Stable: Persistent and reproducible chest discomfort usually precipitated by a physical exertion that dissipates upon cessation of such an activity. The symptoms are manifestations of MYOCARDIAL ISCHEMIA.Hydroxymethylglutaryl-CoA Reductase Inhibitors: Compounds that inhibit HMG-CoA reductases. They have been shown to directly lower cholesterol synthesis.Hospitalization: The confinement of a patient in a hospital.ThiophenesRecurrence: The return of a sign, symptom, or disease after a remission.Cardiovascular Agents: Agents that affect the rate or intensity of cardiac contraction, blood vessel diameter, or blood volume.Rupture, Spontaneous: Tear or break of an organ, vessel or other soft part of the body, occurring in the absence of external force.Retrospective Studies: Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.Registries: The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers.Hirudins: Single-chain polypeptides of about 65 amino acids (7 kDa) from LEECHES that have a neutral hydrophobic N terminus, an acidic hydrophilic C terminus, and a compact, hydrophobic core region. Recombinant hirudins lack tyr-63 sulfation and are referred to as 'desulfato-hirudins'. They form a stable non-covalent complex with ALPHA-THROMBIN, thereby abolishing its ability to cleave FIBRINOGEN.Acetanilides: Compounds based on N-phenylacetamide, that are similar in structure to 2-PHENYLACETAMIDES. They are precursors of many other compounds. They were formerly used as ANALGESICS and ANTIPYRETICS, but often caused lethal METHEMOGLOBINEMIA.Coronary Aneurysm: Abnormal balloon- or sac-like dilatation in the wall of CORONARY VESSELS. Most coronary aneurysms are due to CORONARY ATHEROSCLEROSIS, and the rest are due to inflammatory diseases, such as KAWASAKI DISEASE.Pyrroles: Azoles of one NITROGEN and two double bonds that have aromatic chemical properties.Hospital Mortality: A vital statistic measuring or recording the rate of death from any cause in hospitalized populations.Heparin: A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts.Coronary Restenosis: Recurrent narrowing or constriction of a coronary artery following surgical procedures performed to alleviate a prior obstruction.Thrombosis: Formation and development of a thrombus or blood clot in the blood vessel.Randomized Controlled Trials as Topic: Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.Kaplan-Meier Estimate: A nonparametric method of compiling LIFE TABLES or survival tables. It combines calculated probabilities of survival and estimates to allow for observations occurring beyond a measurement threshold, which are assumed to occur randomly. Time intervals are defined as ending each time an event occurs and are therefore unequal. (From Last, A Dictionary of Epidemiology, 1995)Severity of Illness Index: Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.Multivariate Analysis: A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.Angioscopy: Endoscopic examination, therapy or surgery performed on the interior of blood vessels.Coronary Occlusion: Complete blockage of blood flow through one of the CORONARY ARTERIES, usually from CORONARY ATHEROSCLEROSIS.Triage: The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment.Hirudin Therapy: Use of HIRUDINS as an anticoagulant in the treatment of cardiological and hematological disorders.Drug Therapy, Combination: Therapy with two or more separate preparations given for a combined effect.Cardiac Catheterization: Procedures in which placement of CARDIAC CATHETERS is performed for therapeutic or diagnostic procedures.Double-Blind Method: A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment.Chi-Square Distribution: A distribution in which a variable is distributed like the sum of the squares of any given independent random variable, each of which has a normal distribution with mean of zero and variance of one. The chi-square test is a statistical test based on comparison of a test statistic to a chi-square distribution. The oldest of these tests are used to detect whether two or more population distributions differ from one another.Creatine Kinase: A transferase that catalyzes formation of PHOSPHOCREATINE from ATP + CREATINE. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic ISOENZYMES have been identified in human tissues: the MM type from SKELETAL MUSCLE, the MB type from myocardial tissue and the BB type from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins.Thrombolytic Therapy: Use of infusions of FIBRINOLYTIC AGENTS to destroy or dissolve thrombi in blood vessels or bypass grafts.Proportional Hazards Models: Statistical models used in survival analysis that assert that the effect of the study factors on the hazard rate in the study population is multiplicative and does not change over time.Pravastatin: An antilipemic fungal metabolite isolated from cultures of Nocardia autotrophica. It acts as a competitive inhibitor of HMG CoA reductase (HYDROXYMETHYLGLUTARYL COA REDUCTASES).Platelet Activation: A series of progressive, overlapping events, triggered by exposure of the PLATELETS to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug.Sensitivity and Specificity: Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)Metabolic Syndrome X: A cluster of metabolic risk factors for CARDIOVASCULAR DISEASES and TYPE 2 DIABETES MELLITUS. The major components of metabolic syndrome X include excess ABDOMINAL FAT; atherogenic DYSLIPIDEMIA; HYPERTENSION; HYPERGLYCEMIA; INSULIN RESISTANCE; a proinflammatory state; and a prothrombotic (THROMBOSIS) state. (from AHA/NHLBI/ADA Conference Proceedings, Circulation 2004; 109:551-556)AlbaniaNatriuretic Peptide, Brain: A PEPTIDE that is secreted by the BRAIN and the HEART ATRIA, stored mainly in cardiac ventricular MYOCARDIUM. It can cause NATRIURESIS; DIURESIS; VASODILATION; and inhibits secretion of RENIN and ALDOSTERONE. It improves heart function. It contains 32 AMINO ACIDS.Secondary Prevention: The prevention of recurrences or exacerbations of a disease or complications of its therapy.Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics.Incidence: The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.Logistic Models: Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.Vascular Calcification: Deposition of calcium into the blood vessel structures. Excessive calcification of the vessels are associated with ATHEROSCLEROTIC PLAQUES formation particularly after MYOCARDIAL INFARCTION (see MONCKEBERG MEDIAL CALCIFIC SCLEROSIS) and chronic kidney diseases which in turn increase VASCULAR STIFFNESS.ROC Curve: A graphic means for assessing the ability of a screening test to discriminate between healthy and diseased persons; may also be used in other studies, e.g., distinguishing stimuli responses as to a faint stimuli or nonstimuli.Case-Control Studies: Studies which start with the identification of persons with a disease of interest and a control (comparison, referent) group without the disease. The relationship of an attribute to the disease is examined by comparing diseased and non-diseased persons with regard to the frequency or levels of the attribute in each group.Immunoglobulin Fab Fragments: Univalent antigen-binding fragments composed of one entire IMMUNOGLOBULIN LIGHT CHAIN and the amino terminal end of one of the IMMUNOGLOBULIN HEAVY CHAINS from the hinge region, linked to each other by disulfide bonds. Fab contains the IMMUNOGLOBULIN VARIABLE REGIONS, which are part of the antigen-binding site, and the first IMMUNOGLOBULIN CONSTANT REGIONS. This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme PAPAIN.No-Reflow Phenomenon: Markedly reduced or absent REPERFUSION in an infarct zone following the removal of an obstruction or constriction of an artery.Emergency Medical Services: Services specifically designed, staffed, and equipped for the emergency care of patients.Survival Analysis: A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function.Adenosine: A nucleoside that is composed of ADENINE and D-RIBOSE. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter.Platelet Function Tests: Laboratory examination used to monitor and evaluate platelet function in a patient's blood.Stroke: A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases.Adrenergic beta-Antagonists: Drugs that bind to but do not activate beta-adrenergic receptors thereby blocking the actions of beta-adrenergic agonists. Adrenergic beta-antagonists are used for treatment of hypertension, cardiac arrhythmias, angina pectoris, glaucoma, migraine headaches, and anxiety.Epidemiologic Methods: Research techniques that focus on study designs and data gathering methods in human and animal populations.Death, Sudden, Cardiac: Unexpected rapid natural death due to cardiovascular collapse within one hour of initial symptoms. It is usually caused by the worsening of existing heart diseases. The sudden onset of symptoms, such as CHEST PAIN and CARDIAC ARRHYTHMIAS, particularly VENTRICULAR TACHYCARDIA, can lead to the loss of consciousness and cardiac arrest followed by biological death. (from Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed., 2005)Heparin, Low-Molecular-Weight: Heparin fractions with a molecular weight usually between 4000 and 6000 kD. These low-molecular-weight fractions are effective antithrombotic agents. Their administration reduces the risk of hemorrhage, they have a longer half-life, and their platelet interactions are reduced in comparison to unfractionated heparin. They also provide an effective prophylaxis against postoperative major pulmonary embolism.PiperazinesCalcinosis: Pathologic deposition of calcium salts in tissues.Dalteparin: A low-molecular-weight fragment of heparin, prepared by nitrous acid depolymerization of porcine mucosal heparin. The mean molecular weight is 4000-6000 daltons. It is used therapeutically as an antithrombotic agent. (From Merck Index, 11th ed)Tomography, X-Ray Computed: Tomography using x-ray transmission and a computer algorithm to reconstruct the image.Practice Guidelines as Topic: Directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.Pregnancy-Associated Plasma Protein-A: A product of the PLACENTA, and DECIDUA, secreted into the maternal circulation during PREGNANCY. It has been identified as an IGF binding protein (IGFBP)-4 protease that proteolyzes IGFBP-4 and thus increases IGF bioavailability. It is found also in human FIBROBLASTS, ovarian FOLLICULAR FLUID, and GRANULOSA CELLS. The enzyme is a heterotetramer of about 500-kDa.Myocardial Reperfusion: Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing MYOCARDIAL REPERFUSION INJURY.Receptors, Purinergic P2Y12: A subclass of purinergic P2Y receptors that have a preference for ADP binding and are coupled to GTP-BINDING PROTEIN ALPHA SUBUNIT, GI. The P2Y12 purinergic receptors are found in PLATELETS where they play an important role regulating PLATELET ACTIVATION.Cardiovascular Diseases: Pathological conditions involving the CARDIOVASCULAR SYSTEM including the HEART; the BLOOD VESSELS; or the PERICARDIUM.Emergency Service, Hospital: Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.Cholesterol, LDL: Cholesterol which is contained in or bound to low density lipoproteins (LDL), including CHOLESTEROL ESTERS and free cholesterol.Platelet Aggregation: The attachment of PLATELETS to one another. This clumping together can be induced by a number of agents (e.g., THROMBIN; COLLAGEN) and is part of the mechanism leading to the formation of a THROMBUS.Down Syndrome: A chromosome disorder associated either with an extra chromosome 21 or an effective trisomy for chromosome 21. Clinical manifestations include hypotonia, short stature, brachycephaly, upslanting palpebral fissures, epicanthus, Brushfield spots on the iris, protruding tongue, small ears, short, broad hands, fifth finger clinodactyly, Simian crease, and moderate to severe INTELLECTUAL DISABILITY. Cardiac and gastrointestinal malformations, a marked increase in the incidence of LEUKEMIA, and the early onset of ALZHEIMER DISEASE are also associated with this condition. Pathologic features include the development of NEUROFIBRILLARY TANGLES in neurons and the deposition of AMYLOID BETA-PROTEIN, similar to the pathology of ALZHEIMER DISEASE. (Menkes, Textbook of Child Neurology, 5th ed, p213)Cardiology Service, Hospital: The hospital department responsible for the administration and provision of diagnostic and therapeutic services for the cardiac patient.Anticholesteremic Agents: Substances used to lower plasma CHOLESTEROL levels.Phospholipases A2, Secretory: A subcategory of phospholipases A2 that are secreted from cells. They are 14 kDa proteins containing multiple disulfide-bonds and access their substrate via an interfacial binding site that interacts with phospholipid membranes. In addition specific PHOSPHOLIPASE A2 RECEPTORS can bind to and internalize the enzymes.Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from SEX CHARACTERISTICS, anatomical or physiological manifestations of sex, and from SEX DISTRIBUTION, the number of males and females in given circumstances.Regression Analysis: Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.Takotsubo Cardiomyopathy: A transient left ventricular apical dysfunction or ballooning accompanied by electrocardiographic (ECG) T wave inversions. This abnormality is associated with high levels of CATECHOLAMINES, either administered or endogenously secreted from a tumor or during extreme stress.Cardiac Imaging Techniques: Visualization of the heart structure and cardiac blood flow for diagnostic evaluation or to guide cardiac procedures via techniques including ENDOSCOPY (cardiac endoscopy, sometimes refered to as cardioscopy), RADIONUCLIDE IMAGING; MAGNETIC RESONANCE IMAGING; TOMOGRAPHY; or ULTRASONOGRAPHY.Risk: The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavorable outcome.Antithrombins: Endogenous factors and drugs that directly inhibit the action of THROMBIN, usually by blocking its enzymatic activity. They are distinguished from INDIRECT THROMBIN INHIBITORS, such as HEPARIN, which act by enhancing the inhibitory effects of antithrombins.Diabetic Angiopathies: VASCULAR DISEASES that are associated with DIABETES MELLITUS.Blood Platelets: Non-nucleated disk-shaped cells formed in the megakaryocyte and found in the blood of all mammals. They are mainly involved in blood coagulation.Heart Failure: A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION.Drug-Eluting Stents: Stents that are covered with materials that are embedded with chemicals that are gradually released into the surrounding milieu.Echocardiography: Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic.Myocardium: The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow.Endpoint Determination: Establishment of the level of a quantifiable effect indicative of a biologic process. The evaluation is frequently to detect the degree of toxic or therapeutic effect.Atherosclerosis: A thickening and loss of elasticity of the walls of ARTERIES that occurs with formation of ATHEROSCLEROTIC PLAQUES within the ARTERIAL INTIMA.Glycogen Phosphorylase, Brain Form: An isoenzyme of GLYCOGEN PHOSPHORYLASE that catalyzes the degradation of GLYCOGEN in brain tissue.Point-of-Care Systems: Laboratory and other services provided to patients at the bedside. These include diagnostic and laboratory testing using automated information entry.Diabetes Complications: Conditions or pathological processes associated with the disease of diabetes mellitus. Due to the impaired control of BLOOD GLUCOSE level in diabetic patients, pathological processes develop in numerous tissues and organs including the EYE, the KIDNEY, the BLOOD VESSELS, and the NERVE TISSUE.Postoperative Hemorrhage: Hemorrhage following any surgical procedure. It may be immediate or delayed and is not restricted to the surgical wound.Coronary Artery Bypass, Off-Pump: Coronary artery bypass surgery on a beating HEART without a CARDIOPULMONARY BYPASS (diverting the flow of blood from the heart and lungs through an oxygenator).Survival Rate: The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods.FluorobenzenesMultidetector Computed Tomography: Types of spiral computed tomography technology in which multiple slices of data are acquired simultaneously improving the resolution over single slice acquisition technology.Peptide Fragments: Partial proteins formed by partial hydrolysis of complete proteins or generated through PROTEIN ENGINEERING techniques.Emergency Treatment: First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured.Growth Differentiation Factor 15: A growth differentiation factor that is secreted in response to cell stress and in response to MACROPHAGE ACTIVATION. In addition growth differentiation factor 15 demonstrates a diverse array of biological properties including the induction of cartilage formation, the inhibition of hematopoietic progenitor proliferation, and the induction of neuronal migration.Cardiology: The study of the heart, its physiology, and its functions.Purinergic P2 Receptor Antagonists: Compounds that bind to and block the stimulation of PURINERGIC P2 RECEPTORS.Necrosis: The pathological process occurring in cells that are dying from irreparable injuries. It is caused by the progressive, uncontrolled action of degradative ENZYMES, leading to MITOCHONDRIAL SWELLING, nuclear flocculation, and cell lysis. It is distinct it from APOPTOSIS, which is a normal, regulated cellular process.Middle East: The region of southwest Asia and northeastern Africa usually considered as extending from Libya on the west to Afghanistan on the east. (From Webster's New Geographical Dictionary, 1988)GreecePrevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from INCIDENCE, which refers to the number of new cases in the population at a given time.Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function.Patient Admission: The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution.Patient Readmission: Subsequent admissions of a patient to a hospital or other health care institution for treatment.Atherectomy, Coronary: Percutaneous transluminal procedure for removing atheromatous plaque from the coronary arteries. Both directional (for removing focal atheromas) and rotational (for removing concentric atheromatous plaque) atherectomy devices have been used.JapanPatient Discharge: The administrative process of discharging the patient, alive or dead, from hospitals or other health facilities.Multicenter Studies as Topic: Works about controlled studies which are planned and carried out by several cooperating institutions to assess certain variables and outcomes in specific patient populations, for example, a multicenter study of congenital anomalies in children.Endothelium, Vascular: Single pavement layer of cells which line the luminal surface of the entire vascular system and regulate the transport of macromolecules and blood components.Analysis of Variance: A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable.Diabetes Mellitus: A heterogeneous group of disorders characterized by HYPERGLYCEMIA and GLUCOSE INTOLERANCE.Shock, Cardiogenic: Shock resulting from diminution of cardiac output in heart disease.Radial Artery: The direct continuation of the brachial trunk, originating at the bifurcation of the brachial artery opposite the neck of the radius. Its branches may be divided into three groups corresponding to the three regions in which the vessel is situated, the forearm, wrist, and hand.Neopterin: A pteridine derivative present in body fluids; elevated levels result from immune system activation, malignant disease, allograft rejection, and viral infections. (From Stedman, 26th ed) Neopterin also serves as a precursor in the biosynthesis of biopterin.P-Selectin: Cell adhesion molecule and CD antigen that mediates the adhesion of neutrophils and monocytes to activated platelets and endothelial cells.Propensity Score: Conditional probability of exposure to a treatment given observed covariates.QatarHeart Diseases: Pathological conditions involving the HEART including its structural and functional abnormalities.Myocardial Perfusion Imaging: The creation and display of functional images showing where the blood is flowing into the MYOCARDIUM by following over time the distribution of tracers injected into the blood stream.Patient Selection: Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.Partial Thromboplastin Time: The time required for the appearance of FIBRIN strands following the mixing of PLASMA with phospholipid platelet substitute (e.g., crude cephalins, soybean phosphatides). It is a test of the intrinsic pathway (factors VIII, IX, XI, and XII) and the common pathway (fibrinogen, prothrombin, factors V and X) of BLOOD COAGULATION. It is used as a screening test and to monitor HEPARIN therapy.Angiotensin-Converting Enzyme Inhibitors: A class of drugs whose main indications are the treatment of hypertension and heart failure. They exert their hemodynamic effect mainly by inhibiting the renin-angiotensin system. They also modulate sympathetic nervous system activity and increase prostaglandin synthesis. They cause mainly vasodilation and mild natriuresis without affecting heart rate and contractility.Evidence-Based Medicine: An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006)Vasodilator Agents: Drugs used to cause dilation of the blood vessels.Length of Stay: The period of confinement of a patient to a hospital or other health facility.Statistics, Nonparametric: A class of statistical methods applicable to a large set of probability distributions used to test for correlation, location, independence, etc. In most nonparametric statistical tests, the original scores or observations are replaced by another variable containing less information. An important class of nonparametric tests employs the ordinal properties of the data. Another class of tests uses information about whether an observation is above or below some fixed value such as the median, and a third class is based on the frequency of the occurrence of runs in the data. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed, p1284; Corsini, Concise Encyclopedia of Psychology, 1987, p764-5)Diagnostic Techniques, Cardiovascular: Methods and procedures for the diagnosis of diseases or dysfunction of the cardiovascular system or its organs or demonstration of their physiological processes.Stroke Volume: The amount of BLOOD pumped out of the HEART per beat, not to be confused with cardiac output (volume/time). It is calculated as the difference between the end-diastolic volume and the end-systolic volume.United StatesHypolipidemic Agents: Substances that lower the levels of certain LIPIDS in the BLOOD. They are used to treat HYPERLIPIDEMIAS.Reproducibility of Results: The statistical reproducibility of measurements (often in a clinical context), including the testing of instrumentation or techniques to obtain reproducible results. The concept includes reproducibility of physiological measurements, which may be used to develop rules to assess probability or prognosis, or response to a stimulus; reproducibility of occurrence of a condition; and reproducibility of experimental results.CD40 Ligand: A membrane glycoprotein and differentiation antigen expressed on the surface of T-cells that binds to CD40 ANTIGENS on B-LYMPHOCYTES and induces their proliferation. Mutation of the gene for CD40 ligand is a cause of HYPER-IGM IMMUNODEFICIENCY SYNDROME, TYPE 1.Thromboplastin: Constituent composed of protein and phospholipid that is widely distributed in many tissues. It serves as a cofactor with factor VIIa to activate factor X in the extrinsic pathway of blood coagulation.Thrombectomy: Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called EMBOLECTOMY.EuropeGuideline Adherence: Conformity in fulfilling or following official, recognized, or institutional requirements, guidelines, recommendations, protocols, pathways, or other standards.Collateral Circulation: Maintenance of blood flow to an organ despite obstruction of a principal vessel. Blood flow is maintained through small vessels.Dogs: The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065)Reference Values: The range or frequency distribution of a measurement in a population (of organisms, organs or things) that has not been selected for the presence of disease or abnormality.Dose-Response Relationship, Drug: The relationship between the dose of an administered drug and the response of the organism to the drug.Exercise Test: Controlled physical activity which is performed in order to allow assessment of physiological functions, particularly cardiovascular and pulmonary, but also aerobic capacity. Maximal (most intense) exercise is usually required but submaximal exercise is also used.Death: Irreversible cessation of all bodily functions, manifested by absence of spontaneous breathing and total loss of cardiovascular and cerebral functions.Hemodynamics: The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM.Nephrotic Syndrome: A condition characterized by severe PROTEINURIA, greater than 3.5 g/day in an average adult. The substantial loss of protein in the urine results in complications such as HYPOPROTEINEMIA; generalized EDEMA; HYPERTENSION; and HYPERLIPIDEMIAS. Diseases associated with nephrotic syndrome generally cause chronic kidney dysfunction.Catha: A plant genus of the family CELASTRACEAE. The leafy stems of khat are chewed by some individuals for stimulating effect. Members contain ((+)-norpseudoephedrine), cathionine, cathedulin, cathinine & cathidine.Lipids: A generic term for fats and lipoids, the alcohol-ether-soluble constituents of protoplasm, which are insoluble in water. They comprise the fats, fatty oils, essential oils, waxes, phospholipids, glycolipids, sulfolipids, aminolipids, chromolipids (lipochromes), and fatty acids. (Grant & Hackh's Chemical Dictionary, 5th ed)Nadroparin: A heparin fraction with a mean molecular weight of 4500 daltons. It is isolated from porcine mucosal heparin and used as an antithrombotic agent. (From Merck Index, 11th ed)

Coronary care medicine: it's not your father's CCU anymore. (1/1612)

The management of ST-elevation MI (STEMI) has gone through four phases: 1. The "clinical observation phase"; 2. the "coronary care unit phase"; 3. the "high-technology phase"; and 4. the "evidence-based coronary care phase". A significant advance in the care of patients with acute myocardial infarction that arose as an outgrowth of the evidence-based era was introduction of a lexicon that more accurately reflected contemporary concepts of the pathophysiology underlying myocardial ischemia and infarction. Although considerable improvement has occurred in the process of care for patient with STEMI, room for improvement exists. Despite strong evidence in the literature that prompt use of reperfusion therapy improves survival of STEMI patients such treatment is underutilized and often not administered in an expeditious timeframe relative to the onset of symptom. Even in the reperfusion era, left ventricular dysfunction remains the single most important predictor of mortality following STEMI. After administration of aspirin, initiating reperfusion strategies and, where appropriate, beta blockade all STEMI patients should be considered for inhibition of the renin-angiotensin-aldosterone system. Several adjunctive pharmacotherapies have been investigated to prevent inflammatory damage in the infarct zone. Contrary to earlier beliefs that the heart is a terminally differentiated organ without the capacity to regenerate, evidence now exists that human cardiac myocytes divide after STEMI and stem cells can promote regeneration of cardiac tissue. These observations open up the possibility of myocardial replacement therapy after STEMI.  (+info)

Gender differences in management and outcome in non-ST-elevation acute coronary syndrome. (2/1612)

OBJECTIVE: To study gender differences in management and outcome in patients with non-ST-elevation acute coronary syndrome. DESIGN, SETTING AND PATIENTS: Cohort study of 53 781 consecutive patients (37% women) from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), with a diagnosis of either unstable angina pectoris or non-ST-elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 1998 and 2002, and followed for 1 year. MAIN OUTCOME MEASURES: Treatment intensity and in-hospital, 30-day and 1-year mortality. RESULTS: Women were older (73 vs 69 years, p<0.001) and more likely to have a history of hypertension and diabetes, but less likely to have a history of myocardial infarction or revascularisation. After adjustment, there were no major differences in acute pharmacological treatment or prophylactic medication at discharge. Revascularisation was, however, even after adjustment, performed more often in men (OR 1.15; 95% CI, 1.09 to 1.21). After adjustment, there was no significant difference in in-hospital (OR 1.03; 95% CI, 0.94 to 1.13) or 30-days (OR 1.07; 95% CI, 0.99 to 1.15) mortality, but at 1 year being male was associated with higher mortality (OR 1.12; 95% CI, 1.06 to 1.19). CONCLUSION: Although women are somewhat less intensively treated, especially regarding invasive procedures, after adjustment for differences in background characteristics, they have better long-term outcomes than men.  (+info)

Association between plasma adiponectin levels and unstable coronary syndromes. (3/1612)

AIMS: Obesity is a risk factor for an acute coronary syndrome (ACS). The association between elevated body mass index (BMI) and ACS is independent of most traditional risk factors, suggesting a possible contribution of other body fat-related mediators. This study evaluated the association between adiponectin and ACS. METHODS AND RESULTS: Four hundred and ninety-nine patients undergoing coronary angiography were divided into a subgroup without (n = 331) and with ACS (n = 168). In multiple regression analysis, higher adiponectin levels were independently associated with a lower risk of ACS [odds ratio (OR) = 0.61; 95% CIs: 0.46-0.81; P < 0.001]. In contrast, a higher BMI, a history of myocardial infarction, C-reactive protein, and angiographic coronary artery disease severity were all associated with a higher risk. The greatest increase in risk for ACS was seen at adiponectin levels < or = 5.5 microg/mL. CONCLUSION: Higher plasma adiponectin levels are independently associated with a lower risk of ACS.  (+info)

Pregnancy-associated plasma protein A and proform eosinophilic major basic protein in the detection of different types of coronary artery disease. (4/1612)

Kryptor system was proven to be a rapid, standard method for pregnancy-associated plasma protein A and proform eosinophilic major basic protein (PAPP-A/proMBP) complex detection in coronary artery disease (CAD). No age and/or gender differences in 51 controls and 110 stable coronary artery disease (SCAD) patients were found. SCAD patients did not differ from controls and no difference in PAPP-A/proMBP levels with regards to the number of affected vessels was found. In 21 unstable angina pectoris (UAP), in 35 without and 66 with ST elevation acute myocardial infarctions (NSTEMI, STEMI respectively) patients PAPP-A/proMBP levels were increased (P=0.004 and P<0.0005, respectively). PAPP-A/proMBP levels did not correlate with cardiac troponin I (cTnI) in STEMI and NSTEMI patients. PAPP-A/ proMBP increase was more frequent than cTnI (P=0.036) within the early phase of STEMI. In NSTEMI patients PAPP-A/proMBP positivity was present in 50% of cTnI negative cases. Receiver operating characteristic (ROC) analysis revealed the highest diagnostic accuracy of PAPP-A/proMBP (0.919) in STEMI cTnI positive cases. The highest specificity/sensitivity PAPP-A/proMBP levels for particular acute coronary syndrome (ACS) types were 10.65-14.75 mIU/l. Combination of PAPP-A/proMBP with cTnI increases their diagnostic efficacy within the early phase of ACS. Our results suggest that PAPP-A/proMBP complex is involved in processes preceding vulnerable plaque development in ACS.  (+info)

Effects of revascularization within 14 days of hospital admission due to acute coronary syndrome on 1-year mortality in patients with previous coronary artery bypass graft surgery. (5/1612)

AIMS: To determine whether revascularization within 14 days reduces 1-year mortality in patients with a previous CABG admitted for non-ST-elevation ACS. Current guidelines for patients with acute coronary syndrome (ACS) include early revascularization. The evidence is derived from studies, in which patients with previous coronary artery by-pass graft (CABG) surgery often were excluded and thus insufficient to support a similar strategy in these high-risk patients in whom coronary interventions are associated with lower success and higher complication rates. METHODS AND RESULTS: A cohort of 10 469 patients < 80 years old from a national registry, admitted to coronary care units in Sweden, was studied. We obtained 1-year mortality data from the Swedish National Cause of Death Registry. Relative risk (RR) in patients undergoing revascularization within 14 days (n = 4269) of admission compared to those who did not (n = 6200) was calculated by using multivariable logistic regression analyses and propensity scores for the likelihood of early revascularization. At 1-year, unadjusted mortality was 5.4% in the revascularized group and 13.1% in the conservatively treated group. In multiple regression analyses, revascularization was associated with a reduction of 1-year mortality (RR 0.67; 95% CI, 0.56-0.81; P < 0.001). CONCLUSION: In patients with a previous CABG admitted for ACS, revascularization within 14 days of hospital admission was associated with a marked reduction in 1-year mortality, supporting an early invasive approach also in this subset of patients.  (+info)

Clinical use of clopidogrel in acute coronary syndrome. (6/1612)

Several therapeutic approaches have been developed to improve the outcome among patients with acute coronary syndrome (ACS). However, treatment with antithrombotic therapies such as oral glycoprotein IIb/IIIa inhibitors has been limited by the lack of efficacy and excess bleeding complications. As the publication of the landmark study Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE), the clinical benefit of early and intermediate-term use of combined antiplatelet agents--clopidogrel plus aspirin--in non-ST-segment elevation myocardial infarction (NSTEMI) patients became evident. Pretreatment and intermediate-term therapy with clopidogrel in NSTEMI ACS patients undergoing percutaneous coronary intervention (PCI) was further supported by the PCI-CURE trial. Recently, the results of two major trials Clopidogrel as Adjunctive Reperfusion Therapy-Thrombolysis in Myocardial Infarction 28, Clopidogrel and Metoprolol in Myocardial Infarction Trial established the pivotal role of clopidogrel in the other spectrum of ACS-STEMI. Coupled with the results from previous multicentre trials, these two studies provide a guide for the early and long-term use of clopidogrel in the whole spectrum of ACS. A review summarising the results of the recent clinical trials and a discussion on its implications for the clinical management of ACS is presented.  (+info)

64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome. (7/1612)

BACKGROUND: A high diagnostic accuracy of 64-slice CT coronary angiography (CTCA) has been reported in selected patients with stable angina pectoris, but only scant information is available in patients with non-ST elevation acute coronary syndrome (ACS). OBJECTIVES: To study the diagnostic performance of 64-slice CTCA in patients with non-ST elevation ACS. PATIENTS AND METHODS: 64-slice CTCA was performed in 104 patients (mean (SD) age 59 (9) years) with non-ST elevation ACS. Two independent, blinded observers assessed all coronary arteries for stenosis, using conventional quantitative angiography as a reference. Coronary lesions with >or=50% luminal narrowing were classified as significant. RESULTS: Conventional coronary angiography demonstrated the absence of significant disease in 15% (16/104) of patients, and the presence of single-vessel disease in 40% (42/104) and multivessel disease in 44% (46/104) of patients. Sensitivity for detecting significant coronary stenoses on a patient-by-patient analysis was 100% (88/88; 95% CI 95 to 100), specificity 75% (12/16; 95% CI 47 to 92), and positive and negative predictive values were 96% (88/92; 95% CI 89 to 99) and 100% (12/12; 95% CI 70 to 100), respectively. CONCLUSION: 64-slice CTCA has a high sensitivity to detect significant coronary stenoses, and is reliable to exclude the presence of significant coronary artery disease in patients who present with a non-ST elevation ACS.  (+info)

Relationship between circulating endothelial cells and the predicted risk of cardiovascular events in acute coronary syndromes. (8/1612)

AIMS: The quantification of circulating endothelial cells (CECs) in whole blood is a novel marker of direct endothelial injury and shows promise as a potential biomarker of cardiovascular (CV) risk. The inter-relationship(s) between CECs and predicted CV risk has not been explored in large cohort of 'high-risk' patients. We hypothesized that there would be a significant relationship between increasing CEC counts and predicted CV risk in a broad spectrum of patients presenting with acute coronary syndrome (ACS). METHODS AND RESULTS: We studied 197 patients (aged 40-80 years) admitted with a confirmed diagnosis of unstable angina (UA), non-ST-elevation myocardial infarction (MI, NSTEMI), or ST-elevation MI (STEMI). CEC counts were performed on venous whole blood using the immunobead technique. Four well-validated ACS risk scores [(PURSUIT and TIMI for NSTEMI/UA) TIMI (STEMI) and GRACE (all ACS)] were calculated from the initial clinical history and electrocardiogram, as well as from values of laboratory parameters collected within 12 h of admission. We included a healthy control (HC) group of 50 matched patients in order to quantify the accuracy of CEC counts for the diagnosis of ACS and to compare disease vs. HC counts. CEC counts were significantly higher in the disease group when compared with the HC group. CEC counts significantly increased with increasing severity of disease (that is, UA vs. NSTEMI vs. STEMI; P = 0.002). CEC counts were higher among patients with clinical evidence of heart failure (Killip Class II-IV) when compared with those without (Killip Class I) on admission (P < 0.0001). There was a significant correlation between CEC counts and predicted CV risk for each of the four ACS risk scoring schemes (all P < 0.05). The area under the receiver-operating characteristic (ROC) curve (AUC) for the entire ACS cohort was 0.82 (95% CI: 0.76-0.88; P < 0.0001). A CEC count of >or=7/mL provided a positive predictive value of 90.6% (95% CI: 85.6-95.7%) and a negative predictive value of 53.5% (41.9-65.1%) for the diagnosis of MI (NSTEMI/STEMI) in the presence of an appropriate clinical presentation. CONCLUSION: There is a significant and positive correlation between increasing CECs and increasing CV risk in ACS. The diagnostic accuracy of CECs in this setting is only 'moderate'. Whilst it is good at confirming the presence of MI, a CEC value of <7.0/mL is less reliable at confidently excluding patients without disease.  (+info)

Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syndrome events quickly in any clinical setting. Diagnosis can be made based on patient history, symptoms, electrocardiography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non-ST elevation acute coronary syndrome. Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Coupled with appropriate medical management, percutaneous coronary intervention can improve short- and long-term outcomes following myocardial infarction. If percutaneous coronary intervention cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Fibrinolysis is not recommended in patients with non-ST elevation acute coronary syndrome;
BACKGROUND: In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pathology may range from structurally normal vessels to severe coronary artery disease.. OBJECTIVES: The purpose of this study was to test if coronary computed tomography angiography (CTA) may be used to exclude coronary artery stenosis ≥50% in patients with NSTEACS.. METHODS: The VERDICT (Very Early Versus Deferred Invasive Evaluation Using Computerized Tomography in Patients With Acute Coronary Syndromes) trial (NCT02061891) evaluated the outcome of patients with confirmed NSTEACS randomized 1:1 to very early (within 12 h) or standard (48 to 72 h) invasive coronary angiography (ICA). As an observational component of the trial, a clinically blinded coronary CTA was conducted prior to ICA in both groups. The primary endpoint was the ability of coronary CTA to rule out coronary artery stenosis (≥50% stenosis) in the entire population, expressed as the negative predictive value (NPV), using ICA as ...
The aim of this international study is to describe the short- and long-term (i.e. up to 2 years following the index event) antithrombotic management patterns (AMPs) in patients hospitalized for acute coronary syndromes (ST segment elevation myocardial infarction (STEMI), Non-ST-Segment Elevation Acute Coronary Syndrome (NSTE-ACS)), and to document the impact of AMPs in clinical outcomes, economic variables and quality of life in a real-life setting and to compare these between sites, countries and regions ...
BACKGROUND: Data are limited on whether clinical trials have randomized higher-risk patients over time and how trends in risk profiles and evidence-based pharmacotherapies have influenced trial outcomes. We quantified changes in baseline risk, treatment, and outcomes of patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS) randomized in 9 phase 3 clinical trials of antithrombotic therapy over 15years. METHODS: We studied 58,771 patients in GUSTO IIb, PURSUIT, PARAGON-A, PARAGON-B, PRISM, PRISM-PLUS, GUSTO IV-ACS, SYNERGY, and EARLY ACS. Patient-level data were mapped to 3 pre-specified 5-year randomization periods. Temporal trends in GRACE score-predicted mortality were compared with trends in observed mortality. RESULTS: Over time, in-hospital and discharge use of thienopyridines (p=0.001), statins (p,0.0001), and angiotensin-converting enzyme inhibitors (p,0.0001) increased, and hospital length-of-stay decreased (p=0.024). Blood transfusion use increased (8.3% [1994-98], ...
AIMS: Stroke is an uncommon but serious complication after non-ST-segment elevation acute coronary syndrome (NSTE-ACS). We aimed to identify predictors of stroke within 30 days in patients who suffered NSTE-ACS. METHODS AND RESULTS: We pooled data from six trials (n=31 402) that randomized NSTE-ACS patients either to platelet glycoprotein (GP) IIb/IIIa receptor blockers or to placebo/control therapy. Potential predictors of stroke included treatment, demographic, and clinical characteristics. We identified predictors using univariable and multivariable logistic models, and their performance was evaluated with calibration (Hosmer-Lemeshow test) and discrimination (c-statistic). We found 228 (0.7%) all-cause strokes: 155 (0.5%) non-haemorrhagic, 20 (0.06%) haemorrhagic, and 53 without computed tomography (CT) confirmation. Patients with any type of stroke had a 30-day mortality of 25%. Randomization to GP IIb/IIIa receptor blockers was not significantly associated with all-cause stroke [OR (95% ...
Abstract Background In patients with non-ST-segment elevation acute coronary syndrome (NSTEACS), coronary pa | Jesper J. Linde, Henning Kelbæk, Thomas F. Hansen, | Journal of the American College of Cardiology |
BACKGROUND: Several countries affected by the COVID-19 pandemic have reported a substantial drop in the number of patients attending the emergency department with acute coronary syndromes and a reduced number of cardiac procedures. We aimed to understand the scale, nature, and duration of changes to admissions for different types of acute coronary syndrome in England and to evaluate whether in-hospital management of patients has been affected as a result of the COVID-19 pandemic. METHODS: We analysed data on hospital admissions in England for types of acute coronary syndrome from Jan 1, 2019, to May 24, 2020, that were recorded in the Secondary Uses Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), myocardial infarction of unknown type, or other acute coronary syndromes (including unstable angina). We identified revascularisation procedures undertaken during these admissions (ie, coronary angiography without percutaneous
The purpose of this study is to determine if testing patients for endothelial dysfunction will help identify which patients are more likely at risk to have another heart attack in the future. Study participants will undergo mental stress testing while at the same time being connected to a device that measures endothelial function via the Endopat device. These same participants will also undergo a sleep study via the Watchpat device ...
Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes. Riezebos, R K; Ronner, E; ter Bals, E; Slagboom, T; Smits, P C; ten Berg, J M; Kiemeneij, F; Amoroso, G; Patterson, M S; Suttorp, M J; Tijssen, J G P; Laarman, G J // Heart;May2009, Vol. 95 Issue 10, p807 Background: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeuticsâ€"a practice based on observational and retrospective data. Objective: To compare immediate versus deferred angioplasty in patients... ...
Background. Evaluating the number of medical or interventional treatments of a registry cohort allows the inclusion of women without obstructive CAD, potentially confounding the results toward an apparent sex bias against women.. Aim. The aim of this study was to ascertain whether effective evidence based treatments for acute coronary syndromes (ACS) are underutilized among women with documented coronary disease in various geographic areas compared with men.. Methods. We collected data from 3 registries: the Finnish TACOS (Tampere Acute COronary Syndrome), the British EMMACE 2 (Evaluation of Methods and Management of Acute Coronary Events), and the Argentine PACS-ITALSIA (Prognosis in Acute Coronary Syndromes and the ITALian hospital Sindrome Isquemico Agudo). The gold standard test to which effective discharge treatments were compared was required to be angiographic evidence of obstructive coronary disease (more than 50% lumen diameter stenosis).. Results. The Finnish TACOS, the British EMMACE ...
Objective: To determine the differences in the inflammatory status between diabetic and non-diabetic patients and to evaluate the usefulness of C reactive protein, fibrinogen, and leucocyte count as predictors of death in diabetic patients with unstable coronary disease.. Design: Nested case-control comparisons of the inflammatory status between diabetic and non-diabetic patients. Prospective cohort analysis of C reactive protein concentration, fibrinogen concentration, and leucocyte count as predictors of cardiovascular death in diabetic patients.. Setting: Coronary care unit in Spain.. Participants: 83 diabetic patients with non-ST elevation acute coronary syndrome and 83 sex and aged matched patients selected from 361 non-diabetic patients with non-ST elevation acute coronary syndrome.. Main outcome measures: Plasma concentrations of C reactive protein and fibrinogen, and leucocyte count. Investigators contacted patients to assess clinical events.. Results: Concentrations of C reactive ...
Objective: To analyse intensity of treatment of high-risk patients with non-ST elevation acute coronary syndromes (NSTEACS) included in the DESCARTES (Descripción del Estado de los Sindromes Coronarios Agudos en un Registro Temporal Español) registry.. Patients and setting: Patients with NSTEACS (n = 1877) admitted to 45 randomly selected Spanish hospitals in April and May 2002 were studied.. Design: Patients with ST segment depression and troponin rise were considered high risk (n = 478) and were compared with non-high risk patients (n = 1399).. Results: 46.9% of high-risk patients versus 39.5% of non-high-risk patients underwent angiography (p = 0.005), 23.2% versus 18.8% (p = 0.038) underwent percutaneous revascularisation, and 24.9% versus 7.4% (p , 0.001) were given glycoprotein IIb/IIIa inhibitor. In-hospital and six-month mortality were 7.5% versus 1.1% and 17% versus 4.6% (p , 0.001), respectively. A treatment score (⩾ 4, 2-3 and , 2) was defined according to the number of class I ...
References. 1 Vedanthan R, Seligman B, Fuster V. Global perspective on acute coronary syndrome: a burden on the young and poor. Circ Res. 2014;114(12):1959-75. [ Links ] 2 Ministério da Saúde. Datasus. [internet]. Sistema de informações de mortalidade. Óbitos por residência por ano do óbito segundo capítulo CID-10. Dados preliminares de mortalidade 2011. [Acesso em 2016 nov 22]. Disponível em: http://www.datasus.gov.br [ Links ] 3 Piegas LS, Avezum A, Guimarães HP, Muniz AJ, Reis HJ, Santos ES, et al. Acute coronary syndrome behavior: results of a Brazilian registry. Arq Bras Cardiol. 2013;100(6):502-10. [ Links ] 4 Wiviott SD, Steg PG. Clinical evidence for oral antiplatelet therapy in acute coronary syndromes. Lancet. 2015;386(9990):292-302. [ Links ] 5 Fuster V, Sweeny JM. Aspirin: a historical and contemporary therapeutic overview. Circulation. 2011;123(7):768-78. [ Links ] 6 Eikelboom JW, Mehta SR, Anand SS, Xie C, Fox KA, Yusuf S. Adverse impact of bleeding on prognosis in ...
Doctor answers on Symptoms, Diagnosis, Treatment, and More: Dr. Trettin on acute coronary syndrome: Both are a result of inadequate blood supply to the heart muscle. Acute coronary syndrome means that the imbalance is sufficient to cause symptoms that prompt aggressive intervention, but may not result in permanent heart damage; a myocardial infarction implies that overt heart damage has occurred, hence positive markers of tissue damage. for topic: Acute Coronary Syndrome
Background-Ventricular arrhythmias remain a lethal complication of acute coronary syndromes (ACS). However, the incidence and prognosis of sustained ventricular tachycardia/ventricular fibrillation (VT/VF) in contemporary non-ST-segment elevation (NSTE) ACS populations are not well described. Methods and Results-We examined the incidence of VT/VF and subsequent survival among 9211 patients enrolled in the Early Glycoprotein IIb/IIIa Inhibition in NSTE ACS (EARLY ACS) trial. The cumulative incidence of VT/VF was 1.5% (n=141); 0.6% (n=55) had VT/VF ≤48 hours after enrollment, and 0.9% (n=86) had VT/VF ,48 hours after enrollment. Patients with VT/VF more frequently had prior heart failure, an ejection fraction ,30%, and triple-vessel coronary artery disease. Predictors of sustained VT/VF were similar regardless of the timing of VT/VF (≤48 vs. ,48 hours). Patients with VT/VF ≤48 hours after enrollment had higher 30-day mortality than those who did not have VT/VF ≤48 hours (13.0 vs. 2.2%; ...
Background: Non ST-elevation Acute Coronary Syndromes are the most frequent manifestations of acute ischemic heart disease. Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, difference in outcome between men and women, have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made. The aims of the studies in this thesis were to assess differences between the genders in baseline characteristics, level of care, medical treatment and non-invasive and invasive cardiac procedures. The aims were also to determine gender differences in short and long-term mortality, including impact of level of care, and to determine differences between the genders in benefit from an invasive strategy, with special reference to benefit in women.. Method: We used ...
Objectives: This study sought to investigate long-term outcomes after early or delayed angiography in patients with non-ST-segment elevation acute coronary syndrome (nSTE-ACS) undergoing a routine invasive management. Background The optimal timing of angiography in patients with nSTE-ACS is currently a topic for debate.. Methods: Long-term follow-up after early (within 2 days) angiography versus delayed (within 3 to 5 days) angiography was investigated in the FRISC-II (Fragmin and Fast Revascularization During Instability in Coronary Artery Disease), ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes), and RITA-3 (Intervention Versus Conservative Treatment Strategy in Patients With Unstable Angina or Non-ST Elevation Myocardial Infarction) (FIR) nSTE-ACS patient-pooled database. The main outcome was cardiovascular death or myocardial infarction up to 5-year follow-up. Hazard ratios (HR) were calculated with Cox regression models. Adjustments were made for the FIR risk ...
The paradoxical use of cardiac catheterization in patients with non-ST-elevation acute coronary syndromes: lessons from the Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC /AHA Guidelines (CRUSADE) Quality Improvement Initiative.
Thrombosis Canada is pleased to share two new clinical guides, as well as an educational slide deck on Acute Coronary Syndrome In Hospital Antiplatelet Management. The two new clinical guides can now be accessed through our website and focus on ST Elevation and Non-ST Elevation Acute Coronary Syndrome: Hospital Antiplatelet Management. In addition, a new educational slide desk on the same topic can be viewed or downloaded, in English and French, under the Resources tab of the Thrombosis Canada website.. ...
Objectives: The objectives of this study are to use CART (Classification and regression tree) and step-wise regression to 1) define the predictors of quality of life in ACS (acute coronary syndrome) patients, using demographics, ACS symptoms, and anxiety as independent variables; and 2) discuss and compare the results of these two statistical approaches. Back- ground: In outcome studies of ACS, CART is a good alternative approach to linear regression; however, CART is rarely used. Methods: A descriptive survey design was used with 100 samples recruited. Result and Conclusions: Anxiety is the most significant predictor and also a stronger predictor than symptoms of ACS for the quality of life. The anxiety level patients experienced at the time heart attack occurred can be used to predict quality of life a month later. Furthermore, the majority of ACS patients experienced a moderate to high level of anxiety during a heart attack.
Master thesis, Programme in Medicine TITLE: Predictors of long-term outcome of percutaneous coronary intervention in elderly patients with acute coronary syndrome - a retrospective analysis AUTHOR, YEAR: Maria Lindh, 2012 INSTITUTION, CITY, COUNTRY: Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden BACKGROUND: Elderly patients constitute the majority of patients with acute coronary syndrome. Nevertheless, due to a paucity of data, decision-making on the use of percutaneous coronary intervention in this patient group is mainly empirical. Old age is associated with higher risk of adverse outcome of PCI. It is however not well-known what other factors than age that are of prognostic significance. Likely, considering the heterogeneity of the patient group, there is a subgroup of elderly patients for which the prospects of gaining from intervention are greater than for others. By studying and evaluating factors that may be of prognostic
TY - JOUR. T1 - Duration of eptifibatide infusion after percutaneous coronary intervention and outcomes among high-risk patients with non-ST-segment elevation acute coronary syndrome. T2 - Insights from EARLY ACS. AU - Hess, Connie N.. AU - Schulte, Phillip J.. AU - Newby, L. Kristin. AU - Steg, Philippe Gabriel. AU - Dalby, Anthony J.. AU - Schweiger, Marc J.. AU - Lewis, Basil S.. AU - Armstrong, Paul W.. AU - Califf, Robert M.. AU - van de Werf, Frans. AU - Harrington, Robert A.. PY - 2013/1/1. Y1 - 2013/1/1. N2 - Background and Objectives: Eptifibatide is indicated during percutaneous coronary intervention (PCI) with continuation for 18-24 hours post procedure but is associated with bleeding. We examined the efficacy and safety of shorter post-PCI eptifibatide infusions in high-risk non-ST-segment elevation acute coronary syndrome (NSTE ACS) patients. Methods: EARLY ACS patients treated with PCI and eptifibatide were grouped by post-procedure infusion duration: ,10, 10-13, 13-17, and 17-25 ...
Acute Coronary Syndrome covers the spectrum of clinical conditions ranging from unstable angina to non-ST elevation myocardial infarction and ST elevation myocardial infarction. These life-threatening disorders are a major cause of emergency medical care, hospitalization and mortality. Management of Acute Coronary Syndromes is designed to provide busy clinicians with a comprehensive guide to the investigation, diagnosis and treatment of these syndromes. It encompasses the latest technologies, including the use of biomarkers and non-invasive imaging procedures ...
TY - JOUR. T1 - Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes. AU - Ramanathan, Krishnan. AU - Abel, James G.. AU - Park, Julie E.. AU - Fung, Anthony. AU - Mathew, Verghese. AU - Taylor, Carolyn M.. AU - Mancini, G. B.John. AU - Gao, Min. AU - Ding, Lillian. AU - Verma, Subodh. AU - Humphries, Karin H.. AU - Farkouh, Michael E.. PY - 2017/12/19. Y1 - 2017/12/19. N2 - Background Randomized trial data support the superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (MV-CAD). However, whether this benefit is seen in a real-world population among subjects with stable ischemic heart disease (SIHD) and acute coronary syndromes (ACS) is unknown. Objectives The main objective of this study was to assess the generalizability of the FREEDOM (Future REvascularization Evaluation in Patients with Diabetes Mellitus: Optimal ...
Another name for Acute Coronary Syndrome is Acute Coronary Syndrome. An electrocardiogram or ECG can be an effective tool in the evaluation of acute coronary ...
Platelet aggregation plays a central role in the development of the occlusive thrombus responsible for acute coronary occlusion in people with ACS. People with diabetes have a pro-thrombotic state due to dysfunctional and hyperactive platelets, endothelial dysfunction, elevated coagulation factors and decreased fibrinolysis (32). Increased platelet activity is due to multiple metabolic and cellular factors associated with diabetes that include endothelial dysfunction, the impact of hyperglycemia and deficient insulin action (32).. Diabetes is associated with an increased incidence of recurrent atherothrombotic events (33), including stent thrombosis (34). Anti-platelet therapy has been shown to reduce atherothrombotic events in people with ACS, both during the acute phase and in the longer term. The beneficial effect of ASA has been shown in multiple clinical trials in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and ST-segment elevation MI (STEMI). The ...
Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity in the Arabian Gulf. In this study, the in‐hospital mortality amongst patients admitted with ACS to Arabian Gulf hospitals is predicted using a comprehensive modelling framework that combines powerful machine‐learning methods such as support‐vector machine (SVM), Naïve Bayes (NB), artificial neural networks (NN), and decision trees (DT). The performance of the machine‐learning methods is compared with that of the performance of a commonly used statistical method, namely, logistic regression (LR). The study follows the current practise of computing mortality risk using risk scores such as the Global Registry of Acute Coronary Events (GRACE) score, which has not been validated for Arabian Gulf patients. Cardiac registry data of 7,000 patients from 65 hospitals located in Arabian Gulf countries are used for the study. This study is unique as it uses a contemporary data analytics framework. A k‐fold (k = 10) ...
TY - JOUR. T1 - Current evidence for monitoring platelet reactivity in acute coronary syndrome. T2 - A plea for individualized antiplatelet treatment. AU - Aradi, D.. AU - Sibbing, Dirk. AU - Bonello, Laurent. PY - 2013/9/1. Y1 - 2013/9/1. N2 - Although clopidogrel is more effective in preventing thrombotic complications than aspirin alone in a broad spectrum of patients with ischemic heart disease, many of its limitations were recently brought to light including a delayed onset of action and highly unpredictable P2Y12-receptor inhibition. New-generation ADP-receptor antagonists, such as prasugrel and ticagrelor, were designed and developed to overcome these limitations, providing a more rapid, more reliable and more potent P2Y12-receptor inhibition. These pharmacodynamic benefits of new-generation antiplatelet agents were translated into significant clinical advantage among patients with acute coronary syndrome (ACS), especially in preventing stent thrombosis. However, the downsides of the ...
TY - JOUR. T1 - Current evidence for monitoring platelet reactivity in acute coronary syndrome. T2 - A plea for individualized antiplatelet treatment. AU - Aradi, D.. AU - Sibbing, Dirk. AU - Bonello, Laurent. PY - 2013/9/1. Y1 - 2013/9/1. N2 - Although clopidogrel is more effective in preventing thrombotic complications than aspirin alone in a broad spectrum of patients with ischemic heart disease, many of its limitations were recently brought to light including a delayed onset of action and highly unpredictable P2Y12-receptor inhibition. New-generation ADP-receptor antagonists, such as prasugrel and ticagrelor, were designed and developed to overcome these limitations, providing a more rapid, more reliable and more potent P2Y12-receptor inhibition. These pharmacodynamic benefits of new-generation antiplatelet agents were translated into significant clinical advantage among patients with acute coronary syndrome (ACS), especially in preventing stent thrombosis. However, the downsides of the ...
Acute Coronary Syndromes : Review in-depth clinical information, latest medical news, and guidelines about acute coronary syndrome, classified as either ST segment elevation myocardial infarction (STEMI myocardial infarction) or non-STEMI myocardial infarction (NSTE or non-ST myocardial infarction) as reflected on ECG. Read about the latest angina and STEMI treatment.
CHEST PAIN SUGGESTIVE OF ACUTE CORONARY SYNDROME. Expert Panel on Cardiac Imaging: Leena Mammen, MD1; Suhny Abbara, MD2; Sharmila Dorbala, MD3; Cylen Javidan-Nejad, MD4; Paul R. Julsrud, MD5; Jacobo Kirsch, MD6; Christopher M. Kramer, MD7; Rajesh Krishnamurthy, MD8; Archana T. Laroia, MD9; Amar B. Shah, MD10; Jens Vogel-Claussen, MD11; Richard D. White, MD12; Pamela K. Woodard, MD.13. Summary of Literature Review. Introduction/Background. Acute chest pain is a frequent presenting complaint in emergency departments. Along with other important disease entities such as aortic dissection and pulmonary embolus, such patient symptoms may question the possibility of acute myocardial ischemia. Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non -STEMI (NSTEMI), and unstable angina (UA) [1]. Being able to establish the diagnosis rapidly and accurately may be lifesaving. The immediate cardiac workup consists of an electrocardiogram (ECG) and cardiac biomarkers. ...
... is a chapter in the book, Cardiovascular Medicine, containing the following 18 pages: Stable Coronary Artery Disease, Cocaine-Induced Coronary Vasospasm, Vasospastic Angina, Acute Coronary Syndrome, Acute Coronary Syndrome Immediate Management, Acute Coronary Syndrome Adjunctive Therapy, High Risk Acute Coronary Syndrome Management, Moderate Risk Acute Coronary Syndrome Management, Low Risk Acute Coronary Syndrome Management, Myocardial Infarction Stabilization, Post Myocardial Infarction Evaluation, Post Myocardial Infarction Medications, Cardiac Rehabilitation, Angina Pectoris, Angina Diagnosis, Unstable Angina, Unstable Angina Prognosis, Abnormal Coronary Arteries.
Use of varenicline significantly increased abstinence compared with placebo (39.9% v. 29.1%) 52 weeks after hospital admission for acute coronary syndrome. This finding is important given the substantial reduction in cardiovascular risk conferred by smoking cessation in this high-risk population.1,2,18,19 In addition, rates of serious adverse events (24.5% v. 21.9%) and major adverse cardiovascular events (8.6% v. 9.3%) were similar between varenicline and placebo arms. This suggests that varenicline is safe for use in these patients. However, new strategies for smoking cessation are still needed, given that 60% of smokers who received treatment with varenicline returned to smoking by 1 year after their acute coronary syndrome.. The use of varenicline in the EVITA trial differed in one significant way from the usual method of administration recommended. Typically, patients are instructed to begin taking the drug 8-14 days before a quit date to allow time for titration and bioaccumulation.20 In ...
TY - JOUR. T1 - Novel protein markers of acute coronary syndrome complications in low-risk outpatients. T2 - A systematic review of potential use in the emergency department. AU - Mitchell, Alice. AU - Brown, Michael D.. AU - Menown, Ian B A. AU - Kline, Jeffrey. PY - 2005/11. Y1 - 2005/11. N2 - Background: Published literature was systematically reviewed to determine the diagnostic accuracy of new protein markers of acute coronary syndromes (ACS) in symptomatic outpatients at low risk of ACS and related complications comparable to patients evaluated in emergency department chest pain units. Methods: Studies were identified by a MEDLINE® (1966 to May week 3, 2005) search. Abstracts were reviewed for relevance, and manuscripts were included by the independent consensus of 2 observers based on explicit criteria restricting the analysis to studies relevant to screening ambulatory patients with symptoms suggesting ACS. Publication bias was identified by a modified funnel plot analysis [study size ...
The aim of this study was to investigate the seroprevalence of Helicobacter pylori (HP) in patients with coronary atherosclerosis and acute coronary syndromes. We enrolled 152 patients (group I, 73 patients with acute coronary syndrome; group II, 79 patients with chronic stable angina) and 22 control subjects. An enzyme-linked immunosorbent assay for immunoglobulin (Ig) G test for HP diagnosis was used on all enrolled subjects. C-reactive protein (CRP) was also measured in all patients as an inflammatory marker. Seropositivity rates for HP were significantly higher in patients with coronary artery disease than in controls (80.2% versus 54.5%; P < 0.05). Although CRP level was significantly higher in group I than in group II (1.72 +/- A 2.89 mg/dl versus 0.53 +/- A 0.63 mg/dl, P < 0.0001), HP infection rates were similar between groups (86.3% versus 74.6%, P > 0.05). Infection with HP may influence atherogenesis through low-grade, persistent inflammatory stimulation. However, our data show ...
TY - JOUR. T1 - Emergency cardiac CT for suspected acute coronary syndrome. T2 - Qualitative and quantitative assessment of coronary, pulmonary, and aortic image quality. AU - Dodd, Jonathan D.. AU - Kalva, Sanjeeva. AU - Pena, Antonio. AU - Bamberg, Fabien. AU - Shapiro, Michael D.. AU - Abbara, Suhny. AU - Cury, Ricardo C.. AU - Brady, Thomas J.. AU - Hoffmann, Udo. PY - 2008/9. Y1 - 2008/9. N2 - OBJECTIVE. The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation. MATERIALS AND METHODS. Dedicated coronary 64-MDCT data sets of 50 patients (27 men; mean age, 54 ± 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary ...
The experiments related to the level of cGMP in platelets provided a parameter to determine the biological activity of NO generated by neutrophils. Whereas neutrophils from UA patients increased cGMP levels in the platelet/neutrophil system, neutrophils from AMI patients failed to modify it. Platelets from patients during acute coronary syndromes demonstrated higher basal cGMP levels, which could be attributable not only to the exposure to high levels of NO but also to the nitrate treatment. The results obtained with the exogenous NO-donor, sodium nitroprusside, suggested that there is no defect in the cGMP-forming system in platelets from AMI. In this regard, the increment in the cGMP levels observed with sodium nitroprusside stimulation was very similar in platelets from healthy donors and AMI patients. Taken together, these results could suggest that the increased generation of NO by neutrophils during acute coronary syndromes could be accompanied by the concomitant inactivation of this ...
Acute Coronary Syndromes: A Companion to Braunwalds Heart Disease by Pierre Theroux starting at $5.00. Acute Coronary Syndromes: A Companion to Braunwalds Heart Disease has 1 available editions to buy at Alibris
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A Phase 3, Multicenter, Double-blind, Randomized, Placebo-controlled, Parallel-group Study to Investigate the Efficacy and Safety of CSL112 in Subjects with Acute Coronary Syndrome Treatment for Acute Coronary Syndrome
Adverse impact of bleeding on prognosis in patients with acute coronary syndromes.In persons 30 years or younger, the normal GFR is. estimate glomerular filtration rate from.Normally, healthy people have two kidneys, and their GFR (glomerular filtration rate).Creatinine clearance rates tend to fall later in life as the glomerular filtration rate.Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH Writing Committee Members.The 24-hour urine collection method, or one of the GFR estimation formulas, can more accurately identify the decline in kidney function.RUBY-1: a randomized, double-blind, placebo-controlled trial of the safety and tolerability of the novel oral factor Xa inhibitor darexaban (YM150) following acute coronary syndrome.However, the risk-to-benefit ratio with antithrombotic therapies may be altered in CKD.. Impact of proteinuria and ...
In the current propensity‐matched analysis of contemporary real‐life data, an early invasive strategy was associated with an increased in‐hospital survival in NSTE‐ACS patients with concomitant DM. These results support the 2014 ACCF/AHA guideline recommendations for an early invasive strategy in diabetics, especially those with high‐risk features (eg, NSTEMI and cardiogenic shock).10 Meanwhile, the use of this strategy in lower risk patients, such as those with UA, may not be associated with improved survival.. The survival benefit of an early invasive strategy in the NSTE‐ACS population remains a matter of ongoing debate.20, 21, 22 Whereas none of the landmark trials comparing an early invasive with an initial conservative strategy illustrated a statistically significant reduction in mortality, these trials were not statistically powered to answer that question.21, 22, 23, 24 We calculated the minimal sample size required by a randomized trial to detect the difference in ...
The key pathophysiological process underlying symptomatic coronary artery disease, including acute coronary syndromes (ACS), is usually a rupture or an erosion of an atherosclerotic plaque, followed by platelet activation and subsequent thrombus formation. Early clinical trials showed benefit with long-term aspirin treatment, and later-based on large clinical trials-dual anti-platelet therapy (DAPT), initially with clopidogrel, and more recently with prasugrel or ticagrelor, has become the established treatment in the post-ACS setting and after percutaneous coronary intervention (PCI). Treatment with DAPT is recommended for both ST-elevation myocardial infarction and non-ST-elevation ACS, as well as after PCI with stenting, in American and European clinical guidelines. Notwithstanding the benefits observed with DAPT, including third-generation P2Y(12) receptor inhibitors plus aspirin, ACS patients remain at high risk for a recurrent cardiovascular event, suggesting that other treatment ...
Gastrointestinal bleeding in patients with acute coronary syndromes: incidence, predictors, and clinical implications: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial.
AbstractBackgroundImpaired renal function (IRF) is associated with increased risks of both ischemic and bleeding events. Ticagrelor has been shown to provide greater absolute reduction in ischemic risk following acute coronary syndrome (ACS) in those with versus without IRF.MethodsA pre-specified sub-analysis of the randomized GLOBAL LEADERS trial (n = 15,991) comparing the experimen...
The most common admission indication in the cardiology practice is acute coronary syndrome (ACS) with or without ST-segment elevation. Antithrombotic and anti-ischemic therapies are the cornerstones in the medical management of these syndromes. In patients presenting with ST-segment elevation at the admission electrocardiogram, reperfusion therapy is instituted as fast as possible (1-3), which can be accomplished by primary percutaneous coronary intervention, fibrinolysis, or both. This results in a significant reduction in infarct size and improvement of short- and long-term prognosis (2,3). In patients with coronary syndromes presenting without ST-segment elevation on the admission electrocardiogram, anti-ischemic and antithrombotic therapies are also of utmost importance. However, in the last decade a strong switch has been seen in the invasive approach of this condition. Risk stratification can be improved by angiography, and revascularization-if indicated-can be planned. Several randomized ...
Evidence-based recommendations on prasugrel (Efient) with percutaneous coronary intervention (PCI) for treating acute coronary syndrome (ACS)
Evidence-based recommendations on prasugrel (Efient) with percutaneous coronary intervention (PCI) for treating acute coronary syndrome (ACS)
The article discusses the therapy for patients with acute coronary syndromes (ACS). It provides information on prasugrel, a new antiplatelet agent which offers an alternative pharmacological treatment and was recently cleared for marketing by the U.S. Food and Drug Administration. It also notes that by inhibiting platelet activation, the thienopyridine antiplatelet agents play a crucial role in the adjunctive treatment of patients with ACS ...
Background: The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge forpatients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought toidentify which ACS symptoms are related symptom clusters and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. Methods: In a multisite randomized clinical trial, 3522 patients with known cardiovascular disease were followed up for 2 years. During follow-up, 331 (11%) had a confirmed ACS event. In this group, 8 presenting symptoms were analyzed using cluster analysis. Differences in symptom cluster group characteristics, delay times, and outcomes were examined. Results: The sample was predominately male (67%), older (mean 67.8, S.D. 11.6 years), and white (90%). Four symptom clusters were identified: Classic ACS characterized by chest pain; Pain Symptoms (neck, throat, jaw, back, shoulder, arm pain); ...
Acute Coronary Syndrome. American Heart Association. Retrieved November 25, 2006. Archived September 25, 2006, at the Wayback ... Unlike other causes of acute coronary syndromes, such as unstable angina, a myocardial infarction occurs when there is cell ... Reeder, Guy (27 December 2016). "Nitrates in the management of acute coronary syndrome". www.uptodate.com. Archived from the ... Bagai, A; Dangas, GD; Stone, GW; Granger, CB (6 June 2014). "Reperfusion strategies in acute coronary syndromes". Circulation ...
Acute coronary syndrome[edit]. Acute coronary syndrome frequently presents with retrosternal chest discomfort and difficulty ... acute coronary syndrome, or a large pulmonary embolism.[14] Imaging[edit]. A chest x-ray is useful to confirm or rule out a ... Acute shortness of breath is usually connected with sudden physiological changes, such as laryngeal edema, bronchospasm, ... Pneumothorax presents typically with pleuritic chest pain of acute onset and shortness of breath not improved with oxygen.[2] ...
"Acute Coronary Syndrome Workup". Medscape. Archived from the original on 6 August 2016. Retrieved 14 August 2016. Davidson's ... These are the left main coronary artery and the right coronary artery. The left main coronary artery splits shortly after ... Two small openings above the aortic valve carry blood to the heart itself, the left main coronary artery and the right coronary ... A small amount of blood from the coronary circulation also drains into the right atrium via the coronary sinus, which is ...
... serum lipase or amylase to exclude acute pancreatitis Aspirin increases survival in people with acute coronary syndrome and it ... If acute coronary syndrome ("heart attack") is suspected, many people are admitted briefly for observation, sequential ECGs, ... Acute coronary syndrome Stable or unstable angina Myocardial infarction ("heart attack") - People usually complained of a ... However, both atypical and typical symptoms of acute coronary syndrome can occur, and in general a history cannot be enough to ...
Section 5. Initial management of acute coronary syndromes". Resuscitation. 67 Suppl 1: S87-96. doi:10.1016/j.resuscitation. ... expertly performed primary percutaneous coronary intervention over thrombolytic therapy for acute ST elevation myocardial ... American College of Cardiology (ACC) Door to Balloon (D2B) Initiative Q&A: Improving door-to-balloon time for acute MI - ... November 2006). "Strategies for reducing the door-to-balloon time in acute myocardial infarction". N. Engl. J. Med. 355 (22): ...
Management of Acute Coronary Syndromes. p. 175. New Jersey: Humana Press, 1999. ISBN 0-89603-552-2. Selker HP, Zalenski RJ, ... Smith SW, Whitwam W (February 2006). "Acute coronary syndromes". Emerg. Med. Clin. North Am. 24 (1): 53-89, vi. doi:10.1016/j. ... Acute Coronary Syndromes". Circulation. 112 (24_suppl): IV-89-IV-110. 2005. doi:10.1161/CIRCULATIONAHA.105.166561. PMID ... "Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: ...
acute. Acute bronchitis. chronic. COPD Chronic bronchitis. Acute exacerbations of chronic bronchitis. Acute exacerbation of ... Acute renal failure. Acute respiratory distress syndrome. Acute liver failure. Respiratory failure. Multiple organ dysfunction ... Acute respiratory distress syndrome. Synonyms. Respiratory distress syndrome (RDS), adult respiratory distress syndrome, shock ... acute lung injury, and acute respiratory distress syndrome: time for a reevaluation". Critical Care Medicine. 28 (1): 232-235. ...
... in hospital admissions for acute coronary syndrome. 67% of the decrease occurred in non-smokers. A study published in the ... "Smoke-free legislation and hospitalizations for acute coronary syndrome". The New England Journal of Medicine. 359 (5): 482-491 ... Although nicotine does play a role in acute episodes of some diseases (including stroke, impotence, and heart disease) by its ... The usage of tobacco has also been linked to Buerger's disease (thromboangiitis obliterans) the acute inflammation and ...
2001). "Acute coronary syndromes. The diagnostic role of troponins". Thromb Res. 103 (1): 63-69. doi:10.1016/S0049-3848(01) ... October 1996). "Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes ... in people with chest pain or acute coronary syndrome. A person who recently had a myocardial infarction would have an area of ... "2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American ...
Management of Acute Coronary Syndromes. p. 175. New Jersey: Humana Press, 1999. ISBN 0-89603-552-2. "2005 American Heart ... Eisenman A (2006). "Troponin assays for the diagnosis of myocardial infarction and acute coronary syndrome: where do we stand ... 2005). "Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome". Clin. Chem. 51 (5): ... "Troponin T levels in patients with acute coronary syndromes, with or without renal dysfunction". N Engl J Med. 346 (26): 2047- ...
... Therapy for Cocaine-Association Acute Coronary Syndrome (CAACS). Journal of Medical Toxicology. 2006 Sep;2(3):108- ... Phentolamine also has diagnostic and therapeutic roles in complex regional pain syndrome (reflex sympathetic dystrophy). ... as they can cause unopposed α-adrenergic mediated coronary vasoconstriction, worsening myocardial ischemia and hypertension. It ... Pharmacologic management of complex regional pain syndrome. Clinical Journal of Pain. 2006 Jun;22(5):425-9. http://www.novalar. ...
Aggarwal, RK; Showkathali, R (June 2013). "Rosuvastatin calcium in acute coronary syndromes". Expert Opinion on Pharmacotherapy ... 2006). "Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial" (PDF). JAMA ...
Didangelos A, Simper D, Monaco C, Mayr M (May 2009). "Proteomics of acute coronary syndromes" (PDF). Current atherosclerosis ... May 1998). "Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: ... A number of procedures may also be carried out such as percutaneous coronary intervention, coronary artery bypass graft, or ... Werner syndrome (WS) is a premature aging condition in humans. WS is caused by a genetic defect in a RecQ helicase that is ...
Its use for acute coronary syndrome is of unknown benefit. In Britain and Canada, Entonox and Nitronox are used commonly by ... 2010). "Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and ... and acute coronary syndrome (includes heart attacks). Its use during labour has been shown to be a safe and effective aid for ... This can cause serious neurotoxicity with even acute use, if the user has preexisting vitamin B12 deficiency. Nitrous oxide at ...
Maestroni A, Zecca B, Triggiani M (2006). "Cardiac papillary fibroelastoma presenting with acute coronary syndrome and syncope ... In particular, chest pain or syncope may be due to transient occlusion of the left main coronary artery by the tumor, while a ... a sudden death case of coronary embolism with myocardial infarction". Forensic Sci Int. 113 (1-3): 209-14. doi:10.1016/S0379- ... heart attack or sudden cardiac death may be due to embolization of a portion of the tumor into a coronary artery. If the tumor ...
Lenard L, Aradi D, Donauer E (April 2009). "Migrating Kirschner wire in the heart mimics acute coronary syndrome". Eur Heart J ...
2006). "The obesity paradox in non-ST-segment elevation acute coronary syndromes: Results from the Can Rapid risk ... acute coronary syndrome, older nursing home residents, and chronic obstructive pulmonary disease (COPD). In people with heart ... "The obesity paradox in acute coronary syndrome: a meta-analysis". European Journal of Epidemiology. 29 (11): 801-12. doi: ... "Association of overweight and obesity with patient mortality after acute myocardial infarction: A meta-analysis of prospective ...
Nov 2015). "Effects of dalcetrapib in patients with a recent acute coronary syndrome". N Engl J Med. 367 (22): 2089-99. doi: ...
October 2013). "Alogliptin after acute coronary syndrome in patients with type 2 diabetes". N. Engl. J. Med. 369 (14): 1327-35 ...
Acute infections, such as community-acquired pneumonia (CAP), act as a trigger for acute coronary syndromes (ACS). ACS deals ... "Mechanistic links between acute respiratory tract infections and acute coronary syndromes". Journal of Infection. 66: 1-17. doi ... Overall, pulmonary arterial tension and acute coronary syndromes are few of the many diseases that lead to hypoxia of neuronal ... Complications in this response arise in acute coronary syndromes and pulmonary arterial hypertension. These complications lead ...
"Effects of Dalcetrapib in Patients with a Recent Acute Coronary Syndrome". New England Journal of Medicine. 367 (22): 2089-2099 ... study to evaluate the effects of dalcetrapib on cardiovascular risk in patients with recent acute coronary syndrome bearing the ... Lp-PLA2 is associated with coronary heart disease and stroke.[citation needed] dal-OUTCOMES phase III trial passed its first ... 2012). "Vascular effects and safety of dalcetrapib in patients with or at risk of coronary heart disease: the dal-VESSEL ...
"VISTA-16 Trial: Evaluation of Safety and Efficacy of Short-term A-002 Treatment in Subjects With Acute Coronary Syndrome". ... "Anthera's Varespladib Meets Primary Endpoint In Phase 2 Francis Trial For The Treatment Of Acute Coronary Syndrome" (Press ... "A-002: Short Term (16 week) Treatment of Acute Coronary Syndrome". Anthera Pharmaceuticals, Inc. Retrieved 2011-08-17. Fraser, ... including acute coronary syndrome. In March 2012, Anthera halted further investigation of varespladib per a recommendation from ...
... including acute coronary syndrome and acute chest syndrome. The trial was halted in March 2012 due to inadequate efficacy. ... "VISTA-16 Trial: Evaluation of Safety and Efficacy of Short-term A-002 Treatment in Subjects With Acute Coronary Syndrome". ... "A-002: Short Term (16 week) Treatment of Acute Coronary Syndrome". Anthera Pharmaceuticals. Retrieved 6 September 2011. " ... "Anthera's A-001 Receives Orphan Drug Status For The Prevention Of Acute Chest Syndrome In Patients With Sickle Cell Disease" ( ...
... and urgent coronary revascularization compared with placebo in acute coronary syndrome patients treated with standard medical ... Targeting the unstable plaque in acute coronary syndromes. Clin Ther. 2013 Aug;35(8):1099-107. PMID 23973042 Reuters. 12 April ... GSK announced that the drug had failed to meet Phase III endpoints in a trial of 16,000 patients with acute coronary syndrome ( ... The study failed to reduce the risk of coronary heart disease death, myocardial infarction, ...
The enzyme is one of the "new cardiac markers" which are discussed to improve early diagnosis in acute coronary syndrome. A ... May 2005). "Future biomarkers for detection of ischemia and risk stratification in acute coronary syndrome". Clin. Chem. 51 (5 ... 2005). "Glycogen phosphorylase BB in acute coronary syndromes". Clin. Chem. Lab. Med. 43 (12): 1351-8. doi:10.1515/CCLM. ...
A New Infantile Acute Febrile Mucocutaneous Lymph Node Syndrome (MLNS) Prevailing in Japan. Lühikokkuvõte, PEDIATRICS, 54. ... Marked Acceleration of Atherosclerosis After Lactobacillus casei-Induced Coronary Arteritis in a Mouse Model of Kawasaki ...
Acute coronary syndrome (ACS) is a major health care and economic burden in the United States and accounts for more than 1 ... Acute coronary syndrome.. Makki N1, Brennan TM2, Girotra S3. ... Acute Coronary Syndrome*/diagnosis. *Acute Coronary Syndrome*/ ... The morbidity and mortality due to ACS are substantial-nearly half of all deaths due to coronary heart disease occur following ... Acute Coronary Syndrome*/complications. * ... acute coronary syndrome; management; myocardial infarction; ...
Acute coronary syndrome is a term for a group of conditions that suddenly stop or severely reduce blood from flowing to the ... Acute coronary syndrome is a term for a group of conditions that suddenly stop or severely reduce blood from flowing to the ... Giugliano RP, Braunwald E. Non-ST elevation acute coronary syndromes. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, ... 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American ...
... and guidelines about acute coronary syndrome, classified as either ST segment elevation myocardial infarction (STEMI myocardial ... Acute Coronary Syndromes : Review in-depth clinical information, latest medical news, ...
The American Heart Association explains that acute coronary syndrome is an umbrella term for situations where the blood ... Acute coronary syndromes, just like heart failure and stroke, are much more likely in people who have certain risk factors. ... Chest pain caused by acute coronary syndromes can come on suddenly, as is the case with a heart attack. Other times, the pain ... Treatment for acute coronary syndrome includes medicines and a procedure known as angioplasty, during which doctors inflate a ...
... (ACS) is a term given to a group of symptoms. They are associated with chest pain at rest or during ... is given to all patients suspected of acute coronary syndrome. * Anti-ischemic drugs, such as nitroglycerin. , are used to help ... Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA . 2005; ... Contemporary management of acute coronary syndrome. Postgrad Med J . 2005; 81:217-222. ...
Acute coronary syndrome - Overview covers symptoms, causes and treatment of this condition that causes low blood flow to the ... Acute coronary syndromes. BMJ. 2015;351:h5153.. *Reeder GS, et al. Initial evaluation and management of suspected acute ... Updates and current recommendations for the management of patients with non-ST-elevation acute coronary syndromes: What it ... Acute coronary syndrome. Merck Manual Professional Version. http://www.merckmanuals.com/professional/SearchResults?query=acute+ ...
Acute coronary syndrome (ACS), includes acute myocardial infarction and unstable angina, is common and may prove fatal. ... Patients with acute coronary syndrome allocated to HBOT were associated with a reduction in the risk of death by around 42% (RR ... Hyperbaric oxygen therapy for acute coronary syndrome.. Bennett MH1, Lehm JP, Jepson N. ... Specifically, we addressed:Does the adjunctive administration of HBOT to people with acute coronary syndrome (unstable angina ...
Women younger than 55 years of age who undergo percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) are ... Patients with acute coronary syndromes (ACS) who are at high risk for bleeding have significantly lower rates of target lesion ... Patients with Type 2 diabetes and acute coronary syndromes have a substantially increased risk of death in the 18 months after ... drug-coated stent gives markedly better outcomes than a bare metal stent in patients with acute coronary syndromes and risk ...
... acute myocardial infarction, and sudden cardiac death, are commonly associated with the presence of vulnerable plaques in ... Acute coronary syndromes (ACS), such as unstable angina, ... Acute coronary syndromes (ACS), such as unstable angina, acute ... Acute Coronary Syndrome Hyaluronic Acid Atherosclerotic Lesion Plaque Rupture Vulnerable Plaque These keywords were added by ... Libby P: Molecular bases of the acute coronary syndromes. Circulation 1995, 91:2844-2850.PubMedGoogle Scholar ...
Acute coronary syndrome is usually caused by one of three problems: ST elevation myocardial infarction (STEMI, 30%), non ST ... is a syndrome due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function ... Sitagliptin Pretreatment in Diabetes Patients Presenting with Acute Coronary Syndrome: Results from the Acute Coronary Syndrome ... Sitagliptin Pretreatment in Diabetes Patients Presenting with Acute Coronary Syndrome: Results from the Acute Coronary Syndrome ...
... Topic Overview. What is acute coronary syndrome?. Acute coronary syndrome happens when the heart is ... What causes acute coronary syndrome?. Acute coronary syndrome happens because blood flow has slowed or stopped in the arteries ... Acute coronary syndrome is typically caused by coronary artery disease. Coronary artery disease, also called heart disease, is ... Can acute coronary syndrome be prevented?. A heart-healthy lifestyle can help prevent heart disease, which can lead to acute ...
Patients with acute coronary syndrome, an umbrella term for conditions where the hearts blood supply is suddenly blocked, may ... Patients with acute coronary syndrome at increased risk of suicide. Published Friday 16 December 2016 Published Fri 16 Dec 2016 ... Article: Acute Coronary Syndrome and Suicide: A Case‐Referent Study, Chao‐Han Liu, Ming‐Kung Yeh, Ji‐Hung Wang, Shu‐Chuan Weng ... "Patients with acute coronary syndrome at increased risk of suicide." Medical News Today. MediLexicon, Intl., 16 Dec. 2016. Web. ...
Acute coronary syndrome refers to many conditions that cause sudden, low blood flow to the heart. Know the symptoms, causes and ... Acute coronary syndromes. BMJ. 2015;351:h5153.. *Reeder GS, et al. Initial evaluation and management of suspected acute ... www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/overview-of-acute-coronary-syndromes-acs. ... This test is done only when there are no signs of acute coronary syndrome or another life-threatening heart condition when you ...
The American Heart Association explains that acute coronary syndrome is an umbrella term for situations where the blood ... Acute Coronary Syndrome. So youve never heard of an acute coronary syndrome. But what about heart attack, or unstable angina? ... Acute coronary syndromes, just like heart failure and stroke(link opens in new window), are much more likely in people who have ... Chest pain caused by acute coronary syndromes can come on suddenly, as is the case with a heart attack. Other times, the pain ...
High-sensitivity troponin testing months after an acute coronary syndrome: noise or notable results Peter Kavsak, PJ Devereaux ... Bedside mental status and outcome in elderly patients admitted for acute coronary syndromes Clément Briet, Katrien Blanchart, ... Development and validation of a cardiovascular risk score for patients in the community after acute coronary syndrome Katrina K ... Convalescent troponin and cardiovascular death in patients with acute coronary syndrome Tomoyuki Kawada ...
The number of admissions for acute coronary syndrome decreased after the implementation of smoke-free legislation. A total of ... Smoke-free legislation and hospitalizations for acute coronary syndrome N Engl J Med. 2008 Jul 31;359(5):482-91. doi: 10.1056/ ... Background: Previous studies have suggested a reduction in the total number of hospital admissions for acute coronary syndrome ... These hospitals accounted for 64% of admissions for acute coronary syndrome in Scotland, which has a population of 5.1 million ...
Cardiovascular Outcomes with Alirocumab After Acute Coronary Syndrome Cardiovascular Outcomes with Alirocumab After Acute ... ANNEXA-4: Andexanet For Reversal of Anticoagulation in Factor Xa - Associated Acute Major Bleeding ...
Acute coronary syndrome (ACS) is a common and sometimes lethal event, usually precipitated by sudden rupture and thrombosis of ... "Acute Coronary Syndrome." In Modern Concepts and Practices in Cardiothoracic Critical Care, ed. Adam S. Evans, Gregory E. Kerr ... "Acute Coronary Syndrome." Modern Concepts and Practices in Cardiothoracic Critical Care. IGI Global, 2015. 136-167. Web. 14 Dec ... Acute Coronary Syndrome. Brandon W. Calenda (Icahn School of Medicine at Mount Sinai, USA) and Umesh K. Gidwani (Icahn School ...
Can you pick the Acute Coronary Syndrome? Test your knowledge on this science quiz to see how you do and compare your score to ... Science Quiz / Acute Coronary Syndrome. Random Science or Clickable Quiz QUIZ: Can you pick the Acute Coronary Syndrome?. by r_ ...
Acute Coronary SyndromeA Study to Evaluate the Safety of Apixaban in Acute Coronary Syndrome (ACS) Japanese Patients ... Acute Coronary SyndromeEffectiveness And Safety Of Dalteparin In Patients With Acute Coronary Syndromes Without ST Elevations ... Acute Coronary SyndromeAtorvastatin Pre-Treatment Study In Asian Patients With Acute Coronary Syndrome NCT00728988 ... Acute Coronary Syndrome Intervention Drug: Dalteparin Patients prescribed dalteparin for non-ST segment elevated acute coronary ...
Acute coronary syndrome (ACS) results from thrombus formation at the site of ruptured or eroded atherosclerotic plaques, which ... Routine thienopyridine pretreatment for acute coronary syndrome without ST elevation BMJ 2014; 349 :g6282 ... Routine thienopyridine pretreatment for acute coronary syndrome without ST elevation. BMJ 2014; 349 doi: https://doi.org/ ... West Hertfordshire Hospitals NHS Trust: Consultant Physicians in Acute Medicine (Acute Physicians) ...
Acute coronary syndrome is a broad category of coronary heart disease that ranges from unstable angina to ST elevation ... Among patients with acute coronary syndrome who are not at high risk of bleeding who undergo PCI, either prasugrel or ... Apixaban and rivaroxaban are oral direct factor Xa inhibitors that have been evaluated in acute coronary syndrome (Table 340,41 ... Recent advances in antithrombotic therapy after acute coronary syndrome Message Subject (Your Name) has sent you a message from ...
Care guide for Acute Coronary Syndrome (Discharge Care). Includes: possible causes, signs and symptoms, standard treatment ... Learn more about Acute Coronary Syndrome (Discharge Care). Associated drugs. *Acute Coronary Syndrome ... Acute coronary syndrome (ACS) is sudden decreased blood flow to your heart. This causes a lack of oxygen to your heart and can ... Acute Coronary Syndrome. Medically reviewed by Drugs.com. Last updated on Feb 3, 2020. ...
... life-threatening syndromes.Examines the molecular mechanisms of acute coronary syndromes, inflammation and immunity. Explains ... and more.Discusses special considerations for the care of acute coronary syndromes in the ED and CCU.Offers guidance on the ... management of special populations and chronic patients.Includes guidelines for management of acute coronary syndromes from the ... scientific and clinical information needed to facilitate rapid evaluation and immediate management of acute coronary syndromes ...
In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation ... Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine ... Early markers of acute ischemia include myoglobin and creatine kinase-MB subforms (or isoforms), when available. In the future ... encompasses a range of thrombotic coronary artery diseases, including unstable angina and both ST-segment elevation and non-ST- ...
  • This pattern placed him at high risk for either left main or triple vessel disease and indicates the need for antiplatelet and anti-ischemic therapy and a trip to the catheter laboratory to evaluate coronary anatomy and possible intervention. (nursingcenter.com)
  • These disparities are likely driven at least in part by lower rates of targeted intervention and care strategies for acute heart problems among HIV-positive people, according to a new study. (poz.com)
  • However, evaluation of patients with non-ST-segment elevation is a key issue today because new treatments are focused to a great extent on this group, i.e., low-molecular weight heparins, platelet glycoprotein IIb/IIIa antagonist, direct thrombin inhibitors, and coronary intervention in the acute as well as the subacute phase. (thefreelibrary.com)
  • Acute coronary syndrome (ACS) results from thrombus formation at the site of ruptured or eroded atherosclerotic plaques, which restricts coronary blood flow resulting in myocardial ischemia and injury. (bmj.com)
  • Troponin T or I generally is the most sensitive determinant of acute coronary syndrome, although the MB isoenzyme of creatine kinase also is used. (aafp.org)
  • Yilmaz H, Basarici I. Troponin levels and acute coronary syndrome. (freemd.com)
  • There is a difference between an acute coronary syndrome (unstable coronary plaque) and a non-ACS elevation of troponin. (healio.com)
  • Other medical conditions such as pulmonary embolus, hypertensive emergency and septic shock can elevate the troponin and is NOT a true acute coronary syndrome. (healio.com)
  • Early markers of acute ischemia include myoglobin and creatine kinase-MB subforms (or isoforms), when available. (aafp.org)
  • In the absence of pain, new ST segment changes indicative of ischemia, acute pulmonary edema, ventricular arrhythmias, or hemodynamic instability presumed to be ischemic in origin, will constitute sufficient evidence of ischemia. (clinicaltrials.gov)
  • Medical therapy for acute coronary syndromes is based on drugs that act against ischemia and resultant angina and limit the infarct size (i.e., the area of myocardium that is affected), as well as drugs that inhibit clot formation. (wikipedia.org)
  • Recent studies have shown that OCT is useful for the assessment of coronary atherosclerotic plaques, in particular the assessment of plaque rupture, erosion, and intracoronary thrombus in patients with acute coronary syndrome. (hindawi.com)
  • In a study 2,3 of the natural history of complex (ruptured plaque) and smooth coronary artery lesions performed by analyzing serial coronary arteriograms, we found that complex lesions were frequently preceded by minimally occlusive lesions or seemingly normal vessel segments and that complex lesions were often present in more than 1 vessel simultaneously. (ahajournals.org)
  • We would concur that "pancoronaritis" probably does occur, but that the generalized coronary plaque instability may be present for prolonged periods of time (years) or may be episodic, with periods of stability punctuated with repeated short periods of instability. (ahajournals.org)
  • Unfortunately, the coronary arteriographic appearance of a ruptured plaque does not tell how recently the plaque rupture has occurred. (ahajournals.org)
  • Hence, until then, the presence of multiple lesions indicative of ruptured plaques does not necessarily imply that all the ruptured plaques had occurred at the time of the culprit lesion, nor does it prove that there is necessarily generalized plaque instability at the time of the patient's acute coronary syndrome. (ahajournals.org)
  • Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. (ahajournals.org)
  • Pathophysiology: ACS generally involves rupture of an atherosclerotic plaque in a coronary artery and subsequent thrombus formation. (oncologynurseadvisor.com)
  • Sometimes coronary blood flow isn't blocked by plaque or emboli. (dummies.com)
  • Consequently, we also accessed individual patient-level data from 3 established ACS registries: the Finnish TACOS (Tampere Acute COronary Syndrome), the British EMMACE 2 (Evaluation of Methods and Management of Acute Coronary Events) and the Argentine PACS-ITALSIA (Prognosis in Acute Coronary Syndromes and the ITALian hospital Sindrome Isquemico Agudo). (ingentaconnect.com)
  • people who present with angina must prompt evaluation for possible acute coronary syndrome. (wikipedia.org)
  • Don't miss the "Updates in Acute Coronary Syndrome" session held during SHM's Annual Conference, Hospital Medicine 2018. (hospitalmedicine.org)
  • Patients admitted to the hospital for acute coronary syndrome were likely to have obstructive sleep apnea, according to preliminary findings presented at SLEEP 2018, the Annual Meeting of the Associated Professional Sleep Societies. (healio.com)
  • While there are well-developed guidelines for managing acute coronary syndromes, not all people receive appropriate treatment and there is variation in the type of care received by people in metropolitan compared to non-metropolitan areas. (safetyandquality.gov.au)
  • The guidelines for managing acute coronary syndromes, published in a supplement to the Journal in 2006, provide a readily accessible tool for clinicians to enhance patient care. (mja.com.au)
  • Recently, other invasive indices of coronary physiology including instantaneous wave-free ratio (iFR), index of microvascular resistance (IMR), hyperemic stenosis resistance (HSR), and coronary flow reserve (CFR) have been explored in the context of ACS. (springer.com)
  • FFR is the ratio of the mean coronary pressure distal (Pd) to a stenosis to the mean aortic pressure (Pa) at maximal hyperemia when myocardial resistance is at its presumed absolute minimum. (springer.com)
  • This condition permits pressure and flow to be linearly related, and thus the ratio represents the fraction of normal coronary blood flow across a stenosis with a normal value being 1 (i.e. (springer.com)
  • Significant correlation was not observed between PUFAs profile and severity of coronary stenosis. (unboundmedicine.com)
  • BET 2: Is ST elevation in aVR a sure sign of left main coronary artery stenosis? (bmj.com)
  • The protease-activated receptor 1 inhibitor vorapaxar offers the same benefits to older and younger patients with non-ST segment elevation acute coronary syndromes, shows further analysis of the TRACER trial. (news-medical.net)
  • In acute coronary syndrome, common electrocardiographic abnormalities include T-wave tenting or inversion, ST-segment elevation or depression (including J-point elevation in multiple leads), and pathologic Q waves. (aafp.org)