2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Roffi, Marco; Patrono, Carlo; Collet, Jean‐Philippe; Müeller, Christian; Valgimigli, Marco; Andreotti, Felicita; Bax, Jeroen J.; Borger, Michael A.; Brotons, Carlos; Chew, Derek P.; Gencer, Baran; Hasenfuß, Gerd; Kjeldsen, Keld; Lancellotti, Patrizio; Landmesser, Ulf; Mehilli, Julinda; Mukherjee, Debabrata; Storey, Robert F.; Windecker, Stephan

doi:10.5603/kp.2015.0243

Cited by 210 publications

(210 citation statements)

References 530 publications

(624 reference statements)

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“…Frailty is a geriatric syndrome that reflects a state of decreased physiological reserve and increased vulnerability to stress 26. In daily clinical practice, the decision between a highly invasive approach and a more conservative treatment strategy is mainly based on scores like the European System for Cardiac Operative Risk Evaluation II and the Society of Thoracic Surgeons 27. Both these scores are tailored on clinical variables mainly related to the presence of comorbidities (eg, age, PAD, creatinine clearance, chronic lung disease, previous cardiac surgery, left ventricle ejection fraction, pulmonary intervention and so on).…”

Section: Discussionmentioning

confidence: 99%

“…Both these scores are tailored on clinical variables mainly related to the presence of comorbidities (eg, age, PAD, creatinine clearance, chronic lung disease, previous cardiac surgery, left ventricle ejection fraction, pulmonary intervention and so on). Despite the availability of several standardised measures of physical strength and mobility, only one item of these scores is related to an approximate description of the functional status (eg, severe impairment of mobility secondary to musculoskeletal or neurological dysfunction)27 without a specification of the kind of test to be used. The major drawback for the daily application of the scales assessing physical performance is that they tend to be too long and complex 28.…”

Section: Discussionmentioning

confidence: 99%

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Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis

Pavasini

Serenelli²,

Celis‐Morales

et al. 2018

Heart

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ObjectiveGrip strength is a well-characterised measure of weakness and of poor muscle performance, but there is a lack of consensus on its prognostic implications in terms of cardiac adverse events in patients with cardiac disorders.MethodsArticles were searched in PubMed, Cochrane Library, BioMed Central and EMBASE. The main inclusion criteria were patients with cardiac disorders (ischaemic heart disease, heart failure (HF), cardiomyopathies, valvulopathies, arrhythmias); evaluation of grip strength by handheld dynamometer; and relation between grip strength and outcomes. The endpoints of the study were cardiac death, all-cause mortality, hospital admission for HF, cerebrovascular accident (CVA) and myocardial infarction (MI). Data of interest were retrieved from the articles and after contact with authors, and then pooled in an individual patient meta-analysis. Univariate and multivariate logistic regression was performed to define predictors of outcomes.ResultsOverall, 23 480 patients were included from 7 studies. The mean age was 62.3±6.9 years and 70% were male. The mean follow-up was 2.82±1.7 years. After multivariate analysis grip strength (difference of 5 kg, 5× kg) emerged as an independent predictor of cardiac death (OR 0.84, 95% CI 0.79 to 0.89, p<0.0001), all-cause death (OR 0.87, 95% CI 0.85 to 0.89, p<0.0001) and hospital admission for HF (OR 0.88, 95% CI 0.84 to 0.92, p<0.0001). On the contrary, we did not find any relationship between grip strength and occurrence of MI or CVA.ConclusionIn patients with cardiac disorders, grip strength predicted cardiac death, all-cause death and hospital admission for HF.Trial registration numberCRD42015025280.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis

Pavasini

Serenelli²,

Celis‐Morales

et al. 2018

Heart

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“…In this observational study, patients were treated according to local guidelines, but in order to be selected for the study all sites were required to confirm that local practices were consistent with the guidance issued by the National Institute for Health and Care Excellence11 and the European Society of Cardiology 12…”

Section: Methodsmentioning

confidence: 99%

Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay

Body

Almashali

Morris

et al. 2019

Heart

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ObjectivesThe rapid turnaround time of point-of-care (POC) cardiac troponin (cTn) assays is highly attractive for crowded emergency departments (EDs). We evaluated the diagnostic accuracy of the Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid with a POC cTn assay.MethodsIn a prospective diagnostic accuracy study at eight EDs, we included patients with suspected acute coronary syndromes (ACS). Blood drawn on arrival and 3 hours later was analysed for POC cTnI (i-Stat, Abbott Point of Care). The primary outcome was a diagnosis of ACS, which included both an adjudicated diagnosis of acute myocardial infarction (AMI) based on serial laboratory cTn testing and major adverse cardiac events (death, AMI or coronary revascularisation) within 30 days.ResultsOf 716 patients included, 105 (14.7%) had ACS. Using serial POC cTnI concentrations over 3 hours could have ‘ruled out’ ACS in 198 (31.2%) patients with a sensitivity of 99.0% (95% CI 94.4% to 100.0%) and negative predictive value 99.5% (95% CI 96.5% to 99.9%). No AMIs were missed. T-MACS ‘ruled in’ ACS for 65 (10.4%) patients with a positive predictive value of 91.2% (95% CI 82.1% to 95.9%) and specificity 98.9% (97.6% to 99.6%).ConclusionWith a POC cTnI assay, T-MACS could ‘rule out’ ACS for approximately one-third of patients within 3 hours while ‘ruling in’ ACS for another 10%. The rapid turnaround time and portability of the POC assay make this an attractive pathway for use in crowded EDs or urgent care centres. Future work should also evaluate use in the prehospital environment.

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“…[4,5] Both substances have been adopted into European treatment guidelines, which both recommend the use of these novel P2Y12-inhibitors over clopidogrel for all patients presenting with ACS without overt contraindications. [6–8]…”

Section: Introductionmentioning

confidence: 99%

Contemporary use of P2Y12-inhibitors in patients with acute coronary syndrome undergoing percutaneous coronary intervention in Austria: A prospective, multi-centre registry

et al. 2017

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BackgroundTo this day, there is no data concerning guideline adherence on P2Y12-inhibitors in Austria. Prasugrel and ticagrelor have been shown to be superior to clopidogrel in the treatment of acute coronary syndromes (ACS). However, recent data from European registries showed a reluctant prescription policy with rates of clopidogrel at discharge ranging from 35 to 55%.MethodsIn this prospective, multi-centre registry we assessed prescription rates of P2Y12-inhibitors in patients with ACS in four Austrian PCI centres. Parameters associated with the use of clopidogrel have been evaluated in multivariate logistic regression.ResultsBetween January and June 2015, 808 patients with ACS undergoing PCI were considered for further analysis. 416 (51.5%) presented with STEMI and 392 (48.5%) with NSTE-ACS. Mean age was 65.7 ± 12.4 and 240 (30.9%) were female. Twenty-eight (3.5%) died during the hospital stay. At discharge, 212 (27.2% of all patients) received clopidogrel, 260 (32.2%) prasugrel and 297 (36.8%) ticagrelor, while 11 (1.4%) did not receive any P2Y12-inhibitor. Of those patients, who were discharged with clopidogrel, 117 (55.2%) had no absolute contraindication against a more potent P2Y12-inhibitor. Diagnosis of NSTE-ACS (p<0.001), COPD (p = 0.049), and age (p<0.001) next to factors contributing to absolute contraindication were positively associated with the use of clopidogrel.ConclusionsDespite a high level of care, a considerable number of patients were not treated with the more potent P2Y12-inhibitors. Parameters associated with a presumably higher risk of bleeding and side-effects against the more effective P2Y12 inhibitors were the most prominent factors for the prescription of clopidogrel.

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2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

Cited by 210 publications

References 530 publications

Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis

Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis

Diagnostic accuracy of the T-MACS decision aid with a contemporary point-of-care troponin assay

Contemporary use of P2Y12-inhibitors in patients with acute coronary syndrome undergoing percutaneous coronary intervention in Austria: A prospective, multi-centre registry

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