Chest Pain in a Patient With Coronary Artery Disease Taking Clopidogrel

2013 ◽  
Vol 144 (1) ◽  
pp. e13-e14 ◽  
Author(s):  
Sang Pyo Lee ◽  
Hang Lak Lee ◽  
Kang Nyeong Lee
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Artery Disease

scholarly journals Discrimination capability of pretest probability of stable coronary artery disease: a systematic review and meta-analysis suggesting how to improve validation procedures

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047677
Author(s):  
Pierpaolo Mincarone ◽  
Antonella Bodini ◽  
Maria Rosaria Tumolo ◽  
Federico Vozzi ◽  
Silvia Rocchiccioli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Quality Assessment ◽  
Meta Analysis ◽  
Stable Coronary Artery Disease ◽  
First Line ◽  
Discrimination Capability ◽  
Artery Disease

ObjectiveExternally validated pretest probability models for risk stratification of subjects with chest pain and suspected stable coronary artery disease (CAD), determined through invasive coronary angiography or coronary CT angiography, are analysed to characterise the best validation procedures in terms of discriminatory ability, predictive variables and method completeness.DesignSystematic review and meta-analysis.Data sourcesGlobal Health (Ovid), Healthstar (Ovid) and MEDLINE (Ovid) searched on 22 April 2020.Eligibility criteriaWe included studies validating pretest models for the first-line assessment of patients with chest pain and suspected stable CAD. Reasons for exclusion: acute coronary syndrome, unstable chest pain, a history of myocardial infarction or previous revascularisation; models referring to diagnostic procedures different from the usual practices of the first-line assessment; univariable models; lack of quantitative discrimination capability.MethodsEligibility screening and review were performed independently by all the authors. Disagreements were resolved by consensus among all the authors. The quality assessment of studies conforms to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A random effects meta-analysis of area under the receiver operating characteristic curve (AUC) values for each validated model was performed.Results27 studies were included for a total of 15 models. Besides age, sex and symptom typicality, other risk factors are smoking, hypertension, diabetes mellitus and dyslipidaemia. Only one model considers genetic profile. AUC values range from 0.51 to 0.81. Significant heterogeneity (p<0.003) was found in all but two cases (p>0.12). Values of I2 >90% for most analyses and not significant meta-regression results undermined relevant interpretations. A detailed discussion of individual results was then carried out.ConclusionsWe recommend a clearer statement of endpoints, their consistent measurement both in the derivation and validation phases, more comprehensive validation analyses and the enhancement of threshold validations to assess the effects of pretest models on clinical management.PROSPERO registration numberCRD42019139388.

Screening of Fabry Disease in Patients with Chest Pain Without Obstructive Coronary Artery Disease

2021 ◽  
Author(s):  
Aitor Hernández-Hernández ◽  
Carles Diez-López ◽  
Olga Azevedo ◽  
Julian Palomino-Doza ◽  
Fernando Alfonso ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Fabry Disease ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

scholarly journals Downstream testing after CT coronary angiography: time for a rethink?

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001597
Author(s):  
Gareth Morgan-Hughes ◽  
Michelle Claire Williams ◽  
Margaret Loudon ◽  
Carl A Roobottom ◽  
Alice Veitch ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Communication Systems ◽  
Ct Coronary Angiography ◽  
Second Line ◽  
Recent Onset ◽  
Line Test ◽  
Artery Disease

ObjectiveWe surveyed UK practice and compliance with the National Institute for Health and Care Excellence (NICE) ‘recent-onset chest pain’ guidance (Clinical Guideline 95, 2016) as a service quality initiative. We aimed to evaluate the diagnostic utility and efficacy of CT coronary angiography (CTCA), NICE-guided investigation compliance, invasive coronary angiography (ICA) use and revascularisation.MethodsA prospective analysis was conducted in nine UK centres between January 2018 and March 2020. The reporter decided whether the CTCA was diagnostic. Coronary artery disease was recorded with the Coronary Artery Disease–Reporting and Data System (CAD-RADS). Local electronic records and picture archiving/communication systems were used to collect data regarding functional testing, ICA and revascularisation. Duplication of coronary angiography without revascularisation was taken as a surrogate for ICA overuse.Results5293 patients (mean age, 57±12 years; body mass index, 29±6 kg/m²; 50% men) underwent CTCA, with a 96% diagnostic scan rate. 618 (12%) underwent ICA, of which 48% (298/618) did not receive revascularisation. 3886 (73%) had CAD-RADS 0–2, with 1% (35/3886) undergoing ICA, of which 94% (33/35) received ICA as a second-line test. 547 (10%) had CAD-RADS 3, with 23% (125/547) undergoing ICA, of which 88% (110/125) chose ICA as a second-line test, with 26% (33/125) leading to revascularisation. For 552 (10%) CAD-RADS 4 and 91 (2%) CAD-RADS 5 patients, ICA revascularisation rates were 64% (221/345) and 74% (46/62), respectively.ConclusionsWhile CTCA for recent-onset chest pain assessment has been shown to be a robust test, which negates the need for further investigation in three-quarters of patients, subsequent ICA overuse remains with almost half of these procedures not leading to revascularisation.

ACR Appropriateness Criteria® Acute Nonspecific Chest Pain—Low Probability of Coronary Artery Disease

2012 ◽  
Vol 9 (10) ◽  
pp. 745-750 ◽  
Author(s):  
Udo Hoffmann ◽  
Vikram Venkatesh ◽  
Richard D. White ◽  
Pamela K. Woodard ◽  
J. Jeffrey Carr ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Appropriateness Criteria ◽  
Acr Appropriateness Criteria ◽  
Low Probability ◽  
Artery Disease

scholarly journals Incremental value of QT interval for the prediction of obstructive coronary artery disease in patients with chest pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dong-Hyuk Cho ◽  
Jimi Choi ◽  
Mi-Na Kim ◽  
Hee-Dong Kim ◽  
Soon Jun Hong ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Qt Interval ◽  
Obstructive Coronary Artery Disease ◽  
Model Performance ◽  
Clinical Score ◽  
Qtc Prolongation ◽  
Artery Disease ◽  
Improved Model

AbstractIdentification of obstructive coronary artery disease (OCAD) in patients with chest pain is a clinical challenge. The value of corrected QT interval (QTc) for the prediction of OCAD has yet to be established. We consecutively enrolled 1741 patients with suspected angina. The presence of obstructive OCAD was defined as ≥ 50% diameter stenosis by coronary angiography. The pre-test probability was evaluated by combining QTc prolongation with the CAD Consortium clinical score (CAD2) and the updated Diamond-Forrester (UDF) score. OCAD was detected in 661 patients (38.0%). QTc was longer in patients with OCAD compared with those without OCAD (444 ± 34 vs. 429 ± 28 ms, p < 0.001). QTc was increased by the severity of OCAD (P < 0.001). QTc prolongation was associated with OCAD (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.81–2.85). With QTc, the C-statistics increased significantly from 0.68 (95% CI 0.66–0.71) to 0.76 (95% CI 0.74–0.78) in the CAD2 and from 0.64 (95% CI 0.62–0.67) to 0.74 (95% CI 0.72–0.77) in the UDF score, respectively. QT prolongation predicted the presence of OCAD and the QTc improved model performance to predict OCAD compared with CAD2 or UDF scores in patients with suspected angina.

Abstract P322: Health Status of Stable Patients With Obstructive or Non-Obstructive Coronary Artery Disease Compared With Healthy Controls

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Rosanna Tavella ◽  
Natalie Cutri ◽  
John F Beltrame
Keyword(s):  
Quality Of Life ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Summary Score ◽  
Healthy Controls ◽  
Sf 36 ◽  
Artery Disease

BACKGROUND. Patients with chest pain and no evidence of obstructive coronary artery disease on angiography (NoCAD) are frequently considered not to have significant pathology and their symptoms trivialized. This study compared the health status of patients with NoCAD, obstructive coronary artery disease (CAD) and healthy subjects. METHOD. Patients undergoing angiography within the preceding 12 months for the investigation of chest pain were categorized as NoCAD or CAD on the basis of the angiographic findings and completed a health-related quality of life instrument, the Short Form-36 (SF-36). These were compared with a ‘healthy control’ group that were randomly selected from the electronic white pages and recruited if they had no self-reported history of cardiovascular disease. Cross sectional comparisons between the three groups were age adjusted and performed using liner regression. RESULTS. As shown in the table below, the healthy controls were significantly younger and therefore comparison of SF36 scores were age adjusted. All SF-36 sub-scales (except for bodily pain) and summary scores (see table ), were significantly lower in the CAD and NoCAD groups compared to the healthy controls. There were no differences in SF-36 scores between NoCAD and CAD. CONCLUSION. Compared with a healthy population, patients with stable CAD and NoCAD have significantly poorer quality of life asF-36. Future management strategies need to address the health outcomes in these patients. Healthy Controls (n = 3168) NoCAD (n = 320) CAD (n = 828) Age 52 ± 15 57 ± 12 * 62 ± 11 # SF-36: Physical Summary Score 49 ± 10 41 ± 11 * 41 ± 11 # SF-36: Mental Summary Score 51 ± 10 46 ± 11 * 46 ± 11 # * p <0.01 for healthy controls vs NoCAD, # p <0.01 for healthy controls vs CAD

scholarly journals ACR Appropriateness Criteria® Chronic Chest Pain-Noncardiac Etiology Unlikely-Low to Intermediate Probability of Coronary Artery Disease

2018 ◽  
Vol 15 (11) ◽  
pp. S283-S290
Author(s):  
Amar B. Shah ◽  
Jacobo Kirsch ◽  
Michael A. Bolen ◽  
Juan C. Batlle ◽  
Richard K.J. Brown ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Appropriateness Criteria ◽  
Acr Appropriateness Criteria ◽  
Artery Disease
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