The Year in Non-ST-Segment Elevation Acute Coronary Syndromes

Giugliano, Robert P.; Braunwald, Eugene

doi:10.1016/j.jacc.2005.06.051

Cited by 36 publications

(3 citation statements)

References 150 publications

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“…Predictive accuracy for death or new myocardial infarction at one year has been examined with the aim of identifying patients who may benefit from close monitoring or more aggressive therapy 1,23. The seven variables, including elements of the patient’s medical history that are needed to establish a TIMI score, may not always be immediately available.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction

Harris¹,

Stein²,

Fung³

et al. 2013

VHRM

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BackgroundWe sought to examine the prognostic value of heart rate turbulence derived from electrocardiographic recordings initiated in the emergency department for patients with non-ST elevation myocardial infarction (NSTEMI) or unstable angina.MethodsTwenty-four-hour Holter recordings were started in patients with cardiac symptoms approximately 45 minutes after arrival in the emergency department. Patients subsequently diagnosed with NSTEMI or unstable angina who had recordings with ≥18 hours of sinus rhythm and sufficient data to compute Thrombolysis In Myocardial Infarction (TIMI) risk scores were chosen for analysis (n = 166). Endpoints were emergent re-entry to the cardiac emergency department and/or death at 30 days and one year.ResultsIn Cox regression models, heart rate turbulence and TIMI risk scores together were significant predictors of 30-day (model chi square 13.200, P = 0.001, C-statistic 0.725) and one-year (model chi square 31.160, P < 0.001, C-statistic 0.695) endpoints, outperforming either measure alone.ConclusionMeasurement of heart rate turbulence, initiated upon arrival at the emergency department, may provide additional incremental value in the risk assessment for patients with NSTEMI or unstable angina.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction

Harris¹,

Stein²,

Fung³

et al. 2013

VHRM

View full text Add to dashboard Cite

show abstract

“…Standard heparin is neutralized by protein binding and activated platelets. In addition rebound clinical events have been reported with the discontinuation of UFH [2]. The low-molecular-weight heparins have a more predictable and stable anticoagulant effect with a higher ratio of anti-factor Xa to antifactor IIa, require no monitoring of anticoagulation, lower the incidence of heparin-induced thrombocytopenia, and are resistant to inhibition by activated platelets [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…The thienopyridine derivate clopidogrel is an antiplatelet agent that inhibits the platelet aggregation induced by adenosine diphosphat, thereby reducing ischemic events [4]. Combining this drug with aspirin, which blocks the thromboxan-mediated pathway, has an additive effect [2]. The efficacy and safety of clopidogrel in NSTE-ACS and PCI has been investigated in large randomized trials (CURE [8], PCI-CURE [9]).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in patients with non-ST segment elevation acute coronary syndromes in clinical practice

Heer

Juenger

Gitt

et al. 2008

J Thromb Thrombolysis

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In randomized clinical trials enoxaparin in non ST-elevation acute coronary syndromes (NSTE-ACS) has been shown to be more effective than unfractionated heparin in preventing the combined endpoint of death and myocardial infarction. Clopidogrel in combination with aspirin reduced the combined endpoint of death, myocardial infarction and stroke in NSTE-ACS patients compared to aspirin alone. Aim of the present study was to determine the clinical impact of optimized antithrombotic therapy with enoxaparin, clopidogrel and aspirin compared to standard therapy with unfractionated heparin (UFH) and aspirin in NSTE-ACS in clinical practice. We analyzed data of 2,956 consecutive patients with NSTE-ACS and either antithrombotic therapy with enoxaparin, clopidogrel and aspirin or with aspirin and UFH, which were prospectively enrolled in the acute coronary syndromes registry (ACOS) from July 2000 until the end of November 2002. After adjustment for baseline characteristics and PCI the combined endpoint of hospital death and non-fatal reinfarctions was lower in the group with optimized antithrombotic therapy including clopidogrel, enoxaparin and aspirin compared to the control-group with aspirin and UFH (odds ratio 0.30, 95% confidence interval 0.16-0.53). There was no significant difference in major bleedings between the two treatment groups (1.5% vs. 0.9%, P = 0.35), while overall there were more bleeding complications in the group with optimized antithrombotic therapy (4.9% vs. 2.0%, P = 0.005). In clinical practice optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in NSTE-ACS is associated with a reduction in the combined endpoint of death and non-fatal reinfarctions compared to standard therapy with aspirin and UFH without increase in major bleeding complications.

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2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention

2007

Cathet Cardio Intervent

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The Year in Non-ST-Segment Elevation Acute Coronary Syndromes

Cited by 36 publications

References 150 publications

Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction

Prognostic value of heart rate turbulence for risk assessment in patients with unstable angina and non-ST elevation myocardial infarction

Efficacy and safety of optimized antithrombotic therapy with aspirin, clopidogrel and enoxaparin in patients with non-ST segment elevation acute coronary syndromes in clinical practice

2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention

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