2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Anderson, Jeffrey L.; Adams, Cynthia D.; Antman, Elliott M.; Bridges, Charles R.; Califf, Robert M.; Casey, Donald E.; Chavey, William E.; Fesmire, Francis M.; Hochman, Judith S.; Levin, Thomas N.; Lincoff, A. Michael; Peterson, Eric D.; Théroux, Pierre; Wenger, Nanette K.; Wright, R. Scott; Jneid, Hani; Ettinger, Steven M.; Ganiats, Théodore G.; Philippides, George J.; Jacobs, Alice K.; Halperin, Jonathan L.; Albert, Nancy M.; Creager, Mark A.; DeMets, David L.; Guyton, Robert A.; Kushner, Frederick G.; Ohman, E. Magnus; Stevenson, William G.; Yancy, Clyde W.

doi:10.1161/cir.0b013e318212bb8b

Cited by 682 publications

(390 citation statements)

References 1,279 publications

Supporting

Mentioning

372

Contrasting

Unclassified

Order By: Relevance

“…ACS includes acute ST‐segment elevation myocardial infarction (STEMI), non‐STEMI, and unstable angina 10, 11. The exclusion criteria were cardiac surgery during the previous 4 weeks, end‐stage renal disease requiring dialysis, cerebrovascular disease with neurological deficits, life‐threatening malignancy, obstructive lung disease, and treated SDB.…”

Section: Methodsmentioning

confidence: 99%

Impact of Sleep‐Disordered Breathing on Long‐Term Outcomes in Patients With Acute Coronary Syndrome Who Have Undergone Primary Percutaneous Coronary Intervention

Mazaki

Kasai

Yokoi³

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundSleep‐disordered breathing (SDB) has been recognized as an important risk factor for cardiovascular diseases; however, the impact of SDB on long‐term outcomes in patients with acute coronary syndrome has not been fully evaluated.Methods and ResultsWe performed overnight cardiorespiratory monitoring of 241 patients with acute coronary syndrome who were successfully treated with primary percutaneous coronary intervention between January 2005 and December 2008. The presence of SDB was defined as apnea–hypopnea index ≥5 events per hour. The end point was incidence of major adverse cardiocerebrovascular events, defined as a composite of all‐cause death, recurrence of acute coronary syndrome, nonfatal stroke, and hospital admission for congestive heart failure. Patients were followed for a median period of 5.6 years. Among the 241 patients who were finally enrolled, comorbidity of SDB with acute coronary syndrome was found in 126 patients (52.3%). The cumulative incidence of major adverse cardiocerebrovascular events was significantly higher in patients with SDB than in those without SDB (21.4% versus 7.8%, P=0.006). Multivariable analysis revealed that the presence of SDB was a significant predictor of major adverse cardiocerebrovascular events (hazard ratio 2.28, 95% CI 1.06–4.92; P=0.035).ConclusionsThe study's results showed that the presence of SDB among patients with acute coronary syndrome following primary percutaneous coronary intervention is associated with a higher incidence of major adverse cardiocerebrovascular events during long‐term follow‐up.

show abstract

Section: Methodsmentioning

confidence: 99%

Impact of Sleep‐Disordered Breathing on Long‐Term Outcomes in Patients With Acute Coronary Syndrome Who Have Undergone Primary Percutaneous Coronary Intervention

Mazaki

Kasai

Yokoi³

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…1) PCI performed early after admission (within 4 h) [11,12] according to risk stratification gauged on ECG findings and clinical evaluation reported by running guidelines [12,13]. The resting 12-lead ECG was obtained within 10 min after first medical contact upon arrival of the patient in the emergency room and immediately interpreted by a qualified physician.…”

Section: Patientsmentioning

confidence: 99%

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Ferraro

Biganzoli

Marano

et al. 2013

Clinical Biochemistry

View full text Add to dashboard Cite

Objectives: ST-elevation and non-ST-elevation myocardial infarction (STEMI, NSTEMI) are considered two distinct pathophysiologic entities. We evaluated cardiac troponin I (cTnI) release in STEMI and NSTEMI using a "contemporary" (CV > 10 to 20% at the 99th percentile concentration) cTnI assay for patients undergoing early percutaneous coronary intervention (PCI).Design and methods: 856 patients with suspected acute coronary syndrome consecutively admitted to the Emergency Department of the Maggiore Hospital of Novara (225 STEMI and 135 NSTEMI) were selected according to: 1) early (≤4 h from admission) and successful PCI; and 2) cTnI measurements at ED presentation and within 24 h. The influence of the MI type on cTnI concentrations at baseline and after PCI as well as the velocity of cTnI [cTnI V = absolute increase (after log conversion of cTnI measurements) / delay between the two measurements] was studied by multiple regression analysis, adjusting for patient parameters.Results: A statistically significant interaction between MI type and time from symptoms was reported on cTnI concentrations (p b 0.0001): STEMI and NSTEMI differed for cTnI releases at admission and after revascularization. Higher cTnI V in STEMI was detectable in patients admitted within 6 h from symptoms. Baseline cTnI concentrations were lower in patients with a history of coronary artery disease (CAD) and increased with aging (p b 0.0001). In the elderly (>75 years), the cTnI V was significantly increased.Conclusion: STEMI and NSTEMI patients have different patterns and dynamics of cTnI release influenced by the interaction with time from symptoms, by aging and history of CAD.

show abstract

“…Patients with pleuritic chest pain were subjected to a first-line workup lasting up to 6 hours especially those with history of coronary artery disease or multiple coronary risk factors who were subjected to echocardiography [14][15][16]. Eventually, patients with negative ECGs and negative serum concentrations of troponin I and at least patients with negative echocardiography were considered at very low risk for coronary events and were discharged home [4,5,7,12,17,18]. All the other patients with visceral chest pain and nondiagnostic ECGs were enrolled in the study [1,2].…”

Section: Study Populationmentioning

confidence: 99%

“…Thus, immediate evaluation on presentation to the ED is unreliable to rule out myocardial ischemia, so an updated risk assessment by a 6-hour workup with serial ECGs and serial troponins is needed eventually in patients presenting visceral chest pain to separate patients at high risk for cardiac event who need admission from those at low risk who could be directly discharged. In addition, only patients presenting hard clinical risk profile suspected of myocardial ischemia, beyond first-level workup, could be subjected to further instrumental evaluation [1,2,[4][5][6][7]. Thus, diagnosis of acute coronary syndromes in patients presenting to the ED with chest pain and nondiagnostic ECG, considered at low risk for coronary events, is still a challenge for physicians despite careful observation and diagnostic tools.…”

Section: Introductionmentioning

confidence: 99%

Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram

Conti

Poggioni

Viviani

et al. 2012

The American Journal of Emergency Medicine

View full text Add to dashboard Cite

Aim: The aim of this study is to evaluate incidence of adverse cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram (ECG) and initial troponin. Methods: Prospective, nonrandomized study enrolled low-risk patients with normal ECG and troponin on admission who underwent observation and/or stress testing by unstandardized clinical judgment. Patients who experienced recurrent angina or positive ECGs or positive troponins during observation or patients with positive stress testing were admitted; otherwise, they were discharged. End Point: The end points are cardiac events at short-and long-term follow-up including cardiovascular death, myocardial infarction, unstable angina, and revascularization. Results: Of 5656 patients considered, 1732 with ischemic ECG were initially admitted and, therefore, excluded from the analysis; 2860 with pleuritic chest pain and normal ECG were discharged; 1064 with visceral chest pain and normal ECG were enrolled. Patients with known coronary disease (45%) were older and likely presented known vascular disease. Patients with known vascular disease, older age, female sex, diabetes mellitus, and lower chest pain score were likely managed with observation. In patients with known coronary disease as compared with patients without, overall cardiac events account for 35% vs 14%, respectively (P b .001), as follows: in-hospital, 23% vs 10%, (P b .001); 1 month, 4% vs 2% (P = .133); and 9.9 ± 4.9 months, 8% vs 2%, respectively (P b .001). Conclusions: One-third of patients with chest pain with known coronary disease, negative ECG, and biomarkers were subsequently found to have adverse cardiac events. The value of this research for an emergency medicine audience could be extended to all clinicians and general practitioners beyond cardiologists.

show abstract

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Cited by 682 publications

References 1,279 publications

Impact of Sleep‐Disordered Breathing on Long‐Term Outcomes in Patients With Acute Coronary Syndrome Who Have Undergone Primary Percutaneous Coronary Intervention

Impact of Sleep‐Disordered Breathing on Long‐Term Outcomes in Patients With Acute Coronary Syndrome Who Have Undergone Primary Percutaneous Coronary Intervention

New insights in the pathophysiology of acute myocardial infarction detectable by a contemporary troponin assay

Short- and long-term cardiac events in patients with chest pain with or without known existing coronary disease presenting normal electrocardiogram

Contact Info

Product

Resources

About