Perioperative Normothermia and Incidence of Cardiac Events

2018 ◽  
pp. 18-22
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Controlled Trial ◽  
Standard Of Care ◽  
Perioperative Period ◽  
Cardiac Risk ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
History Of ◽  
Artery Disease

This chapter focuses on how to treat and manage patients with cardiac risk factors during noncardiac surgeries by asking the question: Does maintenance of perioperative normothermia with supplemental warming reduce the incidence of postoperative cardiac events? This was the first prospective, randomized controlled trial to examine the relationship between body temperature and cardiac outcomes in the perioperative period. Patients studied were required either to have a documented history of coronary artery disease or to be considered at high risk for coronary artery disease by established criteria. The study determined that maintenance of normothermia reduces perioperative cardiac morbidity. Maintenance of perioperative normothermia has become the standard of care.

Coronary Artery Disease Screening Using CT Coronary Angiography

2020 ◽  
Vol 91 (10) ◽  
pp. 812-817
Author(s):  
Randy Wang Long Cheong ◽  
Brian See ◽  
Benjamin Boon Chuan Tan ◽  
Choong Hou Koh
Keyword(s):  
Systematic Review ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Cardiac Risk ◽  
Disease Screening ◽  
Ct Coronary Angiography ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Events ◽  
Artery Disease

BACKGROUND: The increased utility of CT coronary angiography (CTCA) in cardiovascular screenings of aircrew has led to the increased detection of asymptomatic coronary artery disease (CAD). A systematic review of studies relevant to the interpretation of CTCA for the occupational fitness assessment of high-risk vocations was performed, with findings used to describe the development of a pathway for the aeromedical disposition of military aviators with asymptomatic CAD.METHODS: Medline was searched using the terms CT coronary angiogram and screening and prognosis. The inclusion criteria were restricted to study populations ages > 18 yr, were asymptomatic, were not known to have CAD, had undergone CTCA, and with their associations with major adverse cardiovascular events (MACE) and other relevant cardiac outcomes reported.RESULTS: Included in this systematic review were 10 studies. When compared to subjects with no or nonobstructive CAD, those with obstructive CAD on CTCA had hazard ratios (HR) for cardiac events ranging from 1.42 to 105.48. Comparing subjects with nonobstructive CAD and those without CAD on CTCA, a lower HR of 1.19 for cardiac events was found. The annual event rates of subjects with no CAD on CTCA were extremely low, ranging from 0 to 0.5%.CONCLUSIONS: Based on the findings, we suggest that CTCA should only be performed in aircrew with higher cardiac risk profiles. Those found to have no CAD or minimal CAD (i.e., 25% stenosis) in a non-left main coronary artery on CTCA can be returned to flying duties. All other results should be further evaluated with an invasive angiogram.Cheong RWL, See B, Tan BBC, Koh CH. Coronary artery disease screening using CT coronary angiography. Aerosp Med Hum Perform. 2020; 91(10):812817.

P2503Clinical outcomes of discordant exercise electrocardiographic and echocardiographic findings in patients with chest pain and no history of coronary artery disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E.-S Im ◽  
I.-S Sohn
Keyword(s):  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Treadmill Exercise ◽  
Coronary Revascularization ◽  
Exercise Echocardiography ◽  
Cardiac Events ◽  
History Of ◽  
Artery Disease

Abstract Purposes The aim of this study was to evaluate comparative clinical outcomes of discordant electrocardiographic (ECG) and echocardiographic (Echo) findings compared to concordant findings during treadmill exercise echocardiography in patients with chest pain and no history of coronary artery disease (CAD). Methods A total of 1725 consecutive patients who underwent treadmill echocardiography with chest pain and no history of CAD were screened. The patients were classified into four groups: ECG−/Echo− (negative ECG and Echo), ECG+/Echo− (positive ECG and negative Echo), ECG−/Echo+, and ECG+/Echo+. Concomitant CAD was determined using coronary angiography or coronary computed tomography. Major adverse cardiac events (MACEs) were defined as a composite of coronary revascularization, acute myocardial infarction, and death. Results MACEs were similar between ECG−/Echo− and ECG+/Echo− groups. Compared to ECG+/Echo− group, ECG−/Echo+ group had more MACEs [adjusted hazard ratio (HR) adjusted by clinical risk factors (95% confidence interval), 3.57 (1.75–7.29), p<0.001]. Compared with ECG+/Echo+ group, ECG−/Echo+ group had lower prevalence of concomitant CAD and fewer MACEs [HR, 0.49 (0.29–0.81), p=0.006]. Conclusions Positive exercise Echo alone during treadmill exercise echocardiography had worse clinical outcomes than positive ECG alone, and the latter had similar outcomes to both negative ECG and Echo. Positive exercise Echo alone also had better clinical outcomes than both positive ECG and Echo. Therefore, exercise Echo findings might be superior for predicting clinical outcomes compared to exercise ECG findings. Additional consideration of ECG findings on positive exercise Echo will also facilitate better prediction of clinical outcomes

scholarly journals Incidence and Predictors of Obstructive Coronary Artery Disease and the Role of Cardiac Troponin Assays in Patients with Unstable Angina

2019 ◽  
Vol 46 (3) ◽  
pp. 161-166 ◽  
Author(s):  
Sushan Yang ◽  
Nirmanmoh Bhatia ◽  
Meng Xu ◽  
John A. McPherson
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Unstable Angina ◽  
Obstructive Coronary Artery Disease ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
History Of ◽  
Male Sex ◽  
Artery Disease ◽  
Long Acting

In a time when cardiac troponin assays are widely used to detect myocardial injury, data remain scarce concerning the incidence and predictors of substantial obstructive coronary artery disease that causes unstable angina. This retrospective single-center study included consecutive patients hospitalized for unstable angina from January 2015 through January 2016. Patients with troponin I levels above the upper reference limit and those who did not undergo angiography were excluded. Multivariate logistic regression analysis was used to identify predictors of obstructive coronary artery disease that warranted revascularization and of major adverse cardiac events up to 6 months after discharge from the hospital. Of the 114 patients who met the inclusion criteria, 46 (40%) had obstructive coronary artery disease. In the univariate analysis, male sex, white race, history of coronary artery disease, prior revascularization, hyperlipidemia, chronic kidney disease, aspirin use, long-acting nitrate use, and Thrombolysis in Myocardial Infarction score ≥3 were associated with obstructive coronary artery disease. History of coronary artery disease, prior revascularization, hyperlipidemia, and long-acting nitrate use were associated with major adverse cardiac events. Male sex was an independent predictor of obstructive coronary artery disease (adjusted odds ratio=4.82; 95% CI, 1.79–13; P=0.002) in the multivariate analysis. Our results showed that coronary artery disease warranting revascularization is present in a considerable proportion of patients who have unstable angina. The association that we found between male sex and obstructive coronary artery disease suggests that the risk stratification of patients presenting with unstable angina may need to be refined to improve outcomes.

Lifestyle management and secondary prevention of coronary artery disease

2021 ◽  
pp. 97-102
Author(s):  
Mansoor Ahmad ◽  
Sandra A. Weiss ◽  
William S. Weintraub
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Secondary Prevention ◽  
Recurrent Events ◽  
Lifestyle Modification ◽  
Heart Association ◽  
Prevention Measures ◽  
Cardiac Events ◽  
History Of ◽  
Artery Disease

Cardiovascular disease has been the leading cause of death in industrialized nations since the early 1900s. According to the American Heart Association, there are more than 1 million new and recurrent cardiac events occurring each year. Those with a history of cardiac ischaemic events have a high risk of recurrent events; however, the death rate from coronary artery disease declined from 1995 to 2005 by 26%. Thus, the burden of chronic non-fatal coronary artery disease remains high and therefore underscores the importance of secondary prevention measures. This chapter focuses on lifestyle modification, which is considered a major component of secondary prevention.

scholarly journals Prevention, Detection and Management of Coronary Artery Disease in Minority Females

2015 ◽  
Vol 25 (4) ◽  
pp. 499 ◽  
Author(s):  
Renee Patrice Bullock-Palmer
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cause Of Death ◽  
Cardiac Risk ◽  
The United States ◽  
Cardiac Morbidity ◽  
Minority Females ◽  
Artery Disease ◽  
Stable Cad

<p class="Pa7"><strong>Background and Significance: </strong>Heart dis­ease is the leading cause of death for wom­en living in the United States; this disease claims more female lives than all cancers combined. Additionally, according to the Centers of Disease Control data between the years 1979 and 2006, while cardiac-related mortality among men decreased significantly, only a modest decline was found among women. This disparity is great­est among minority females including Blacks and Hispanics who have an even greater prevalence of CVD and its risk factors</p><p class="Pa7"><strong>Prevention: </strong>There are several risk factors for coronary artery disease (CAD). Modifi­able risk factors include: tobacco smoking, hypertension, diabetes, hyperlipidemia, obesity and physical inactivity. The preven­tion of CAD is grounded in decreasing or removing these modifiable risk factors.</p><p class="Pa7"><strong>Detection: </strong>Accurately diagnosing CAD is dependent on an accurate assessment of the patient’s pre-test probability to determine the best diagnostic approach to pursue. The patient’s functional status, resting EKG and cardiac risk factors also assist in determining the best non-invasive cardiac test to pursue.</p><p class="Pa7"><strong>Management: </strong>The goals and mainstay in the management of minority females with stable CAD includes surveillance for CAD symptoms, management of hypertension, diabetes mellitus and hyperlipidemia, as well as encouraging healthy habits.</p><p><strong>Conclusion: </strong>Heart disease remains the leading cause of death in minority females. Providers must be diligent to aggressively decrease patients’ cardiovascular risk and, when patients do present with cardiovascu­lar symptoms, providers must be aggressive in accurately diagnosing and treating these patients to decrease cardiac morbidity and mortality. <em>Ethn Dis. </em>2015;25(4):499-506; doi:10.18865/ed.25.4.499</p>

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