Long-term risk factors from non-invasive evaluation of patients with acute chest pain, but without myocardial infarction

Introduction: Coronary computed tomography angiography (cCTA) allows efficient triage of low-intermediate risk patients with suspected acute coronary syndrome (ACS); appropriate management of patients with moderate stenosis by cCTA is unknown. We evaluated the yield of downstream testing in moderate stenosis patients in a clinical ED cCTA registry. Methods: All consecutive ED patients with acute chest pain undergoing cCTA as part of routine care between October 2012 and July 2014 were screened. Patients with moderate as their worst stenosis (50-69% stenosis) on cCTA were included. Plaque characteristics, resting left ventricular function (by cCTA), results of any functional downstream non-invasive testing, invasive coronary angiography (ICA) and interventions, and discharge diagnosis were reported. ACS was defined as acute myocardial infarction (MI) or unstable angina pectoris (UAP) and adjudicated by an independent committee. Ischemia was defined as clear, territorial abnormality by myocardial perfusion scintigraphy imaging (MPI) or rest or stress echocardiogram, significant dynamic ST-T shift by exercise treadmill test (ETT) and stenosis >70% on ICA or fractional flow reserve (FFR) <0.75. Results: 586 patients underwent cCTA, with 7.2% (n=42) deemed moderate stenosis. Rate of ACS was 14.2% (n=6) with all adjudicated as UAP. Of these, 83% had stenosis caused by lipid-rich plaque; 33% had wall motion abnormalities on cCTA. The majority (n=28; 66%) underwent downstream non-invasive testing. Overall, n=2 (6%) of the non-invasive tests were positive for ischemia while n=3 (42%) of the invasive tests were diagnosed as positive for ischemia (all revascularized) (Figure 1). Conclusions: Unstable angina but not myocardial infarction is frequent among acute chest pain patients with moderate stenosis by cCTA. cCTA findings of lipid-rich plaque and resting functional abnormalities had a relatively higher yield vs. other non-invasive tests to detect ischemia.

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The long-term predictive value of an exercise thallium-201 scintigraphy for patients with acute chest pain but without myocardial infarction

Coronary Artery Disease ◽

10.1097/00019501-199302000-00010 ◽

1993 ◽

Vol 4 (2) ◽

pp. 195-200 ◽

Cited By ~ 2

Author(s):

Jeppe Launbjerg ◽

Per Fruergaard ◽

Henrik L. Jacobsen ◽

Hans E. Utne ◽

Johan Reiber ◽

...

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Predictive Value ◽

Acute Chest Pain ◽

Thallium 201 ◽

Thallium 201 Scintigraphy

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Public Response to Chest Pain in Jordan

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2005.03.001 ◽

2005 ◽

Vol 4 (2) ◽

pp. 139-144 ◽

Cited By ~ 2

Author(s):

Saafan A. AL-Safi ◽

Ahmad S. Alkofahi ◽

Hala S. El-Eid

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Chest Pain ◽

Community Education ◽

Public Awareness ◽

Acute Chest Pain ◽

Poor Response ◽

Public Health Education ◽

Left Shoulder ◽

Optimal Response

Background: Chest pain is one of the main and most frequent manifestations of myocardial infarction (MI). Increased level of public awareness on the optimal response to chest pain due to MI attacks is crucial for minimizing its complications and mortality rate. Aims: The first aim of this investigation was to assess the level of public awareness on their response to acute chest pain. The second aim was to obtain information about self-reported risk factors for coronary heart disease and acute myocardial infarction. Settings and design: This survey was conducted in various regions of Jordan during the period of July–September 2004. A total of 4194 adults (out of 4500), 2086 males (49.7%) and 2108 females (50.3%) resident in Jordan were included in the sample. The response rate was 92.3%. Methods: Each individual of the sample who agreed voluntarily to participate in the investigation was asked to report in a questionnaire his/her possible risk factors for MI. Moreover, each person of the sample was asked “What do you do when you suffer from a severe and crushing chest pain that persists for longer than 15 min and radiates to jaws, neck or left shoulder, with sweating and paleness of the face?” The person was asked to choose one option out of 11. Statistical analysis: The frequency and percentage were determined for each investigated parameter. Results and conclusion: The highest percentage of respondents had good response by selecting the option “I go to a doctor” while the lowest percentage of respondents showed poor response by choosing the option “I use an antacid”. The remainder of responses was distributed among other options. Excellent awareness was reported by 47% of the sample. Differences in the type of responses were detected when the results were analyzed according to gender, type of job, level of education and ethnicity. Approximately half of the interviewed individuals of the sample had 2–4 clustering risk factors for developing acute MI attacks. Individuals in more than half of the sample had family history of hypertension and diabetes mellitus. It is concluded that although the type of response to chest pain in Jordan is good–excellent, more improvement is recommended since the risk to MI is relatively high. Community education campaigns may participate in increasing public health education on the optimal response to chest pain of myocardial origin.

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Characteristics and long-term outcome of patients with acute chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to whether they were hospitalized or directly discharged from the emergency department

Coronary Artery Disease ◽

10.1097/00019501-200202000-00005 ◽

2002 ◽

Vol 13 (1) ◽

pp. 37-43 ◽

Cited By ~ 5

Author(s):

Johan Herlitz ◽

Björn W. Karlson ◽

Jonny Lindqvist ◽

Margareta Sjölin

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Chest Pain ◽

Acute Chest Pain ◽

Term Outcome ◽

Long Term Outcome

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Plasma Fibrinopeptide A and Beta-Thromboglobulin in Patients with Chest Pain

Thrombosis and Haemostasis ◽

10.1055/s-0038-1665250 ◽

1983 ◽

Vol 50 (02) ◽

pp. 541-542 ◽

Cited By ~ 13

Author(s):

J T Douglas ◽

G D O Lowe ◽

C D Forbes ◽

C R M Prentice

Keyword(s):

Myocardial Infarction ◽

Chest Pain ◽

Unstable Angina ◽

Plasma Levels ◽

Thrombin Generation ◽

Acute Chest Pain ◽

Fibrinopeptide A ◽

Control Hospital ◽

Hospital Patients ◽

Platelet Release

SummaryPlasma levels of β-thromboglobulin (BTG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in 48 patients within 3 days of admission to hospital for acute chest pain. Twenty-one patients had a confirmed myocardial infarction (MI); 15 had unstable angina without infarction; and 12 had chest pain due to noncardiac causes. FPA and BTG were also measured in 23 control hospital patients of similar age. Mean plasma BTG levels were not significantly different in the 4 groups. Mean plasma FPA levels were significantly higher in all 3 groups with acute chest pain when compared to the control subjects (p < 0.01), but there were no significant differences between the 3 groups. Increased FPA levels in patients with acute chest pain are not specific for myocardial infarction, nor for ischaemic chest pain.

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Non-invasive Risk Stratification Early After a Myocardial Infarction—The Risk Estimation Following Infarction Non-invasive Evaluation (REFINE) Study

US Cardiology Review ◽

10.15420/usc.2008.5.1.10 ◽

2008 ◽

Vol 5 (1) ◽

pp. 10-11

Author(s):

Derek V Exner

Keyword(s):

Myocardial Infarction ◽

Risk Stratification ◽

Risk Estimation ◽

Non Invasive ◽

Invasive Evaluation

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Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2961 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Wienbergen ◽

A Fach ◽

S Meyer ◽

J Schmucker ◽

R Osteresch ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Risk Factor ◽

Prevention Program ◽

Study Endpoint ◽

Funding Source ◽

Risk Factor Control ◽

One Year

Abstract Background The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after >24 months (“prevention boost”) is effective. Methods In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control. In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention. Results At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p<0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p<0.05, Figure 1). A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p<0.05 between the groups, Figure 1). Conclusions IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after >24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)

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Heparin Neutralizing Activity in the Diagnosis of Acute Myocardial Infarction

10.1055/s-0039-1689202 ◽

1975 ◽

Author(s):

J. R. O’Brien ◽

M. D. Etherington ◽

S. Jamieson ◽

J. Sussex

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Chest Pain ◽

Acute Chest Pain ◽

Platelet Factor 4 ◽

Clotting Time ◽

Platelet Factor ◽

Neutralizing Activity ◽

Platelet Poor Plasma ◽

Activated Platelets

We have previously demonstrated that, relative to controls, patients long after myocardial infarction and patients with atherosclerosis have highly significantly shorter heparin thrombin clotting times (HTCT) using platelet poor plasma; but there was considerable overlap between the two groups.We have now studied 89 patients admitted with acute chest pain. In 54 of these a firm diagnosis of acute myocardial infarction (ac-MI) was made and the HTCT was very short (mean 12.8 sees) and in 48 it was less than 16 sees. In 34 patients, ac-MI was excluded and the diagnosis was usually “angina”; the HTCT was much longer (mean 25.1 sees) and in 32 it was over 16 sees. Thus there was almost no overlap between these two groups. It is suggested that this test should be adopted as a quick and reliable further test to establish a diagnosis of ac-MI (providing other reasons for very short HTCTs can be excluded, e.g. D. I. C., and provinding the patient’s thrombin clotting time is normal).This HTCT measures non-specific heparin neutralizing activity; nevertheless the evidence suggests that it is measuring platelet factor 4 liberated from damaged or “activated” platelets into the plasma. These findings underline the probable important contribution of platelets in ac-MI.

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