Chest Pain Network with Support of Telemedicine: Impact on Reperfusion Therapy and Clinical Outcomes After 8 Years of Experience

Background Insertion of a balloon-expandable stent (BES) in patients with symptomatic intracranial atherosclerosis is a treatment option for reperfusion therapy. In this study, we retrospectively reviewed clinical outcomes during long-term follow-up after insertion of balloon-expandable stents in patients with symptomatic middle cerebral artery (MCA) stenosis. Methods Institutional review board approval was obtained for retrospective review of patient data. Thirty-four patients (15 men, 19 women; median age, 67.5 years) with symptomatic MCA stenosis underwent balloon-expandable stent insertion between June 2008 and December 2010. Patient records were reviewed for angiographic findings and clinical outcomes during long-term follow-up. Results Of these patients, 22 presented with acute ischemic stroke with underlying MCA atherosclerosis and had good clinical outcomes (modified Rankin Scale score (mRS): 0–2) after reperfusion therapy. Indications for stenting for the remaining 12 patients were recurrent transient ischemic attacks (TIAs) refractory to medical therapy and MCA stenosis greater than 70%. During the poststenting follow-up period, which ranged from 61 to 108 months (median, 67.5 months), a TIA occurred in five patients. Of these five patients, one experienced a complete reocclusion of the MCA stent, and three had symptomatic restenosis. The remaining 29 patients did not experience any further ischemic events or restenosis during the follow-up period. Conclusions In our study, treatment with balloon-expandable stents in patients with symptomatic MCA stenosis resulted in low recurrence rates for both ischemic events and restenosis during long-term follow-up.

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A PREDICTORS OF RECURRENT CHEST PAIN IN PATIENTS WITH VASOSPASTIC ANGINA ON 3-YEAR CLINICAL OUTCOMES

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)61844-1 ◽

2014 ◽

Vol 63 (12) ◽

pp. A1841

Author(s):

Seung-Woon Rha ◽

Byoung Geol Choi ◽

Se Yeon Choi ◽

Yoonjee Park ◽

akkala goud ◽

...

Keyword(s):

Chest Pain ◽

Clinical Outcomes ◽

Vasospastic Angina

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Abstract 169: Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.169 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Abhishek Sharma ◽

Samin Sharma ◽

Debabrata Mukherjee ◽

Akash Garg ◽

Carl Lavie ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Beta Blockers ◽

Final Analysis ◽

Reperfusion Therapy ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Standard Medical Therapy ◽

St Segment ◽

Early Use

Background: It remains unclear if early use of intravenous (IV) beta-blockers (iBB) improves clinical outcomes patients with ST-segment elevation myocardial infarction (MI; STEMI), especially among those who received reperfusion therapy. Objective: To evaluate effect of early iBB use on clinical outcomes among patients with STEMI. Methods: A systematic review of randomized control trials in MEDLINE, EMBASE, CINAHL, and Cochrane databases comparing early use (administered within 12 hours of presentation) of iBB with standard medical therapy/placebo among patients who presented with STEMI. The effect of iBB was assessed by stratifying studies into pre-reperfusion and reperfusion trials and pooled treatment effects were estimated using relative risk with Mantel-Haenszel risk ratio, using a random-effects model Results: Twenty-one studies (N=74,801) were selected for final analysis. Clinical outcomes at 30 days and 1 year are summarized in table below. Conclusion: In the current reperfusion era, early use of iBB in patients with STEMI was associated with reduction in the risk of recurrent MI and ventricular tachyarrhythmias without any significant reduction in all-cause or CV mortality or increase in the risk of cardiogenic shock.

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Abstract T P158: Albuminuria Is Associated With Neurological Deterioration and Poor Outcome in Acute Stroke Patients With Non-valvular Atrial Fibrillation: The SAMURAI-NVAF Study

Stroke ◽

10.1161/str.46.suppl_1.tp158 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Takayuki Matsuki ◽

Masatoshi Koga ◽

Shoji Arihiro ◽

Kenichi Todo ◽

Hiroshi Yamagami ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Clinical Outcomes ◽

Reperfusion Therapy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Multicenter Observational Study ◽

Spot Urine ◽

Poor Outcome ◽

The Impact

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

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Rationale and design of a cohort study evaluating triage of acute chest pain in out-of-hours primary care in the Netherlands (TRACE)

Primary Health Care Research & Development ◽

10.1017/s1463423620000122 ◽

2020 ◽

Vol 21 ◽

Author(s):

Amy Manten ◽

Cuny J.J. Cuijpers ◽

Remco Rietveld ◽

Emma Groot ◽

Freek van de Graaf ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Chest Pain ◽

The Netherlands ◽

Clinical Outcomes ◽

Acute Chest Pain ◽

Urgent Care ◽

Triage System ◽

Out Of Hours ◽

Coronary Syndrome

Abstract The aims of this study are (1) to evaluate the performance of current triage for chest pain; (2) to describe the case mix of patients undergoing triage for chest pain; and (3) to identify opportunities to improve performance of current Dutch triage system for chest pain. Chest pain is a common symptom, and identifying patients with chest pain that require urgent care can be quite challenging. Making the correct assessment is even harder during telephone triage. Temporal trends show that the referral threshold has lowered over time, resulting in overcrowding of first responders and emergency services. While various stakeholders advocate for a more efficient triage system, careful evaluation of the performance of the current triage in primary care is lacking. TRiage of Acute Chest pain Evaluation in primary care (TRACE) is a large cohort study designed to describe the current Dutch triage system for chest pain and subsequently evaluate triage performance in regard to clinical outcomes. The study consists of consecutive patients who contacted the out-of-hours primary care facility with chest pain in the region of Alkmaar, the Netherlands, in 2017, with follow-up for clinical outcomes out to August 2019. The primary outcome of interest is ‘major event’, which is defined as the occurrence of death from any cause, acute coronary syndrome, urgent coronary revascularization, or other high-risk diagnoses in which delay is inadmissible and hospitalization is necessary. We will evaluate the performance of the triage system by assessing the ability of the triage system to correctly classify patients regarding urgency (accuracy), the proportion of safe actions following triage (safety) as well as rightfully deployed ambulances (efficacy). TRACE is designed to describe the current Dutch triage system for chest pain in primary care and to subsequently evaluate triage performance in regard to clinical outcomes.

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Variations in Responding to Chest Pain, Ambulance Utilisation and Clinical Outcomes Among 10 Ethnic Groups: Time, Ethnicity, and Delay (TED) Study III

Heart Lung and Circulation ◽

10.1016/j.hlc.2019.06.568 ◽

2019 ◽

Vol 28 ◽

pp. S378

Author(s):

K. Wechkunanukul ◽

S. Ullah

Keyword(s):

Chest Pain ◽

Clinical Outcomes ◽

Ethnic Groups

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