non-ST-elevation Acute Coronary Syndromes (non-st-elevation + acute_coronary_syndrome)

Distribution by Scientific Domains


Selected Abstracts


Treatment Strategies in Non-ST-Elevation Acute Coronary Syndromes in Patients Undergoing Percutaneous Coronary Intervention: An Evidence-Based Review of Clinical Trial Results and Treatment Guidelines: Report on a Roundtable Discussion

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2008
F.A.C.C., MARC COHEN M.D.
With the availability of new data and the recent release of new European and US guidelines, contemporary care paradigms for the treatment of patients with non-ST-elevation acute coronary syndromes (NSTE ACS), including those undergoing percutaneous coronary intervention, are likely to undergo substantial changes. In recognition of this shifting landscape as well as the impact of new guidelines on care models for the treatment of patients with NSTE ACS, a roundtable was convened on October 25, 2007, to discuss the implications of these changes. The purpose of this review is to summarize the presentations and subsequent discussions from the roundtable, which examined the guidelines and evidence from a variety of perspectives, and to explore the best ways to incorporate new treatment paradigms into everyday clinical care. The multiple viewpoints expressed by the roundtable attendees illustrate the recognition that at this point, consensus has not been reached on the optimum algorithm for treatment of these patients. This article focuses on issues discussed during the roundtable from the perspective of the practicing cardiologist. [source]


Clinical Assessment of Ischemia-modified Albumin and Heart Fatty Acid,binding Protein in the Early Diagnosis of Non-ST-elevation Acute Coronary Syndrome in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 1 2010
Sandrine Charpentier MD
Abstract Objectives:, Heart fatty acid,binding protein (h-FABP) and ischemia-modified albumin (IMA) have recently been evaluated, but to the best of our knowledge, no study has reported an analysis of these two markers for the detection of early myocardial infarction and myocardial ischemia in a large cohort of consecutive patients presenting to an emergency department (ED). This study evaluates the diagnostic accuracy and the clinical utility of h-FABP and IMA for non-ST-segment elevation acute coronary syndrome (ACS) diagnosis in the first hour of management in an ED. Methods:, In a prospective 11-month study, 677 patients admitted to the ED with chest pain and suspected non-ST-segment elevation ACS were enrolled. On presentation, blood samples were obtained for the measurement of the biomarkers h-FABP (immunodetection with CardioDetect) and IMA (albumin cobalt-binding test). Two physicians, blinded to the results of the markers, independently categorized patients as having or not having non-ST-segment elevation ACS. Results:, Of the 677 patients who were prospectively recruited, non-ST-segment elevation ACS was diagnosed in 185 (27.3%). While IMA was not predictive of the ACS diagnosis (odds ratio [OR] = 1.23; 95% CI = 0.87 to 1.81), h-FABP was predictive of ACS diagnosis (OR = 4.65; 95% CI = 2.39 to 9.04) with specificity at 96.8% (95% CI = 95.4% to 98.1%) and sensitivity at 13.5% (95% CI = 10.9% to 16.1%). However, h-FABP did not add significant additional information to a predictive model that included the usual diagnostic tools for non-ST-elevation ACS management (p = 0.40). Conclusions:, In this study on a large cohort of patients admitted to an ED for chest pain, IMA and h-FABP did not provide valuable information for ACS diagnosis. ACADEMIC EMERGENCY MEDICINE 2010; 17:27,35 2010 by the Society for Academic Emergency Medicine [source]


High postclopidogrel platelet reactivity in non-ST-elevation acute coronary syndrome treated with stenting: a clue for adverse prognosis?

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 3 2006
M. GALVANI
[source]


Anticoagulation with the direct thrombin inhibitor argatroban in patients presenting with acute coronary syndromes,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2009
Robert W. Yeh MD
Abstract Objectives: This study examined the efficacy and safety of the direct thrombin inhibitor argatroban in patients presenting with acute coronary syndromes undergoing cardiac catheterization. Background: Argatroban is a direct-thrombin inhibitor approved for use in percutaneous coronary intervention in patients with heparin-induced thrombocytopenia. Few studies have examined its use in patients undergoing cardiac catheterization for acute coronary syndromes. We performed a retrospective cohort study of patients presenting with acute coronary syndromes who received argatroban anticoagulation during cardiac catheterization. Methods: Consecutive patients presenting with acute coronary syndromes who received argatroban while undergoing cardiac catheterization from 2002 to 2005 were included. Patient characteristics and in-hospital outcomes were examined retrospectively via detailed chart review. The primary endpoints of the study were combined death, myocardial infarction or urgent revascularization, and major bleeding during the index hospitalization. Results: A total of 144 patients presenting with an acute coronary syndrome received argatroban during cardiac catheterization within the study period: 25% presented with ST-elevation myocardial infarction and 75% presented with non-ST-elevation acute coronary syndrome. The combined endpoint of death, myocardial infarction or urgent revascularization occurred in 13.2% of patients during the hospitalization. Major bleeding occurred in 2.1% of patients. Conclusions: In this cohort of patients presenting with acute coronary syndromes, patients receiving argatroban during cardiac catheterization had a moderate rate of adverse cardiac events and a very low rate of major bleeding. 2009 Wiley-Liss, Inc. [source]


Bleeding risk with AZD6140, a reversible P2Y12 receptor antagonist, vs. clopidogrel in patients undergoing coronary artery bypass grafting in the DISPERSE2 trial

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2009
S. Husted
Summary AZD6140, the first reversible oral P2Y12 receptor antagonist, exhibits greater and more consistent inhibition of platelet aggregation than the irreversible thienopyridine clopidogrel. As a result of its reversible effect, AZD6140 may pose less risk for bleeding when antiplatelet treatment cannot be stopped at least 5 days before coronary artery bypass graft (CABG) surgery or other invasive procedures. The Dose conflrmation Study assessing anti-Platelet Effects of AZD6140 vs. clopidogRel in NSTEMI (DISPERSE2) trial showed overall comparable bleeding rates with antiplatelet treatment with AZD6140 90 mg twice daily or 180 mg twice daily vs. clopidogrel 75 mg once daily in 984 patients with non-ST-elevation acute coronary syndromes. A post hoc exploratory analysis of bleeding outcomes in the subset of 84 patients undergoing CABG in DISPERSE2 suggests reduced risk for total bleeding (41% and 58% vs. 62%), all major bleeding (38% and 50% vs. 62%), and life-threatening bleeding (22% and 38% vs. 54%) with AZD6140 90 mg (n = 32) and 180 mg (n = 26) vs. clopidogrel (n = 26) respectively. Trends suggested that major bleeding rates were reduced with AZD6140 (combined groups) vs. clopidogrel when treatment was stopped , 5 days prior to surgery (39% vs. 63%, p = 0.15) but not when treatment was stopped > 5 days before surgery (50% vs. 60%). This observation is consistent with the reversible binding of AZD6140 to the P2Y12 receptor. Further prospective studies are planned to assess the relationship between this potential clinical benefit of AZD6140 and the reversibility of its antiplatelet effects. [source]


Treatment Strategies in Non-ST-Elevation Acute Coronary Syndromes in Patients Undergoing Percutaneous Coronary Intervention: An Evidence-Based Review of Clinical Trial Results and Treatment Guidelines: Report on a Roundtable Discussion

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2008
F.A.C.C., MARC COHEN M.D.
With the availability of new data and the recent release of new European and US guidelines, contemporary care paradigms for the treatment of patients with non-ST-elevation acute coronary syndromes (NSTE ACS), including those undergoing percutaneous coronary intervention, are likely to undergo substantial changes. In recognition of this shifting landscape as well as the impact of new guidelines on care models for the treatment of patients with NSTE ACS, a roundtable was convened on October 25, 2007, to discuss the implications of these changes. The purpose of this review is to summarize the presentations and subsequent discussions from the roundtable, which examined the guidelines and evidence from a variety of perspectives, and to explore the best ways to incorporate new treatment paradigms into everyday clinical care. The multiple viewpoints expressed by the roundtable attendees illustrate the recognition that at this point, consensus has not been reached on the optimum algorithm for treatment of these patients. This article focuses on issues discussed during the roundtable from the perspective of the practicing cardiologist. [source]


A Review of Clinical Trials with Eptifibatide in Cardiology

CARDIOVASCULAR THERAPEUTICS, Issue 4 2007
Uwe Zeymer
ABSTRACT Glycoprotein (GP) IIb/IIIa receptor antagonists inhibit the binding of ligands to activated platelet GP IIb/IIIa receptors and, therefore, prevent the formation of platelet thrombi. Additional antithrombin therapy should be given in connection with GP IIb/IIIa administration. Eptifibatide is a small heptapeptide, which is highly selective and rapidly dissociates from its receptor after cessation of therapy. In clinical trials (IMPACT-II and ESPRIT) concomitant administration of eptifibatide to patients undergoing percutaneous coronary intervention (PCI) reduced thrombotic complications. In the PURSUIT trial, in patients with non-ST-elevation acute coronary syndromes, eptifibatide, compared to placebo, significantly reduced the primary endpoint of death and nonfatal myocardial infarction at 30 days. In patients with STEMI eptifibatide has been studied as an adjunct to fibrinolysis and primary PCI; it improved epicardial flow and tissue reperfusion. Current studies are evaluating eptifibatide as upstream therapy in high-risk patients with NSTE-ACS, in the EARLY-ACS and in comparison with abciximab in patients with primary PCI in the EVA-AMI trial. [source]


Continuous 12-lead electrocardiographic ST monitoring adds prognostic information to the thrombolysis in myocardial infarction risk score in patients with non-ST-elevation acute coronary syndromes

CLINICAL CARDIOLOGY, Issue 4 2005
Michael N. Zairis M.D.
Abstract Background: Continuous 12-lead electrocardiographic (ECG) ST monitoring and the Thrombolysis In Myocardial Infarction Risk Score (TIMI-RS), both have been shown to be useful for early risk stratification in patients with non-ST elevation acute coronary syndromes (NSTACS). Hypothesis: Transient ST ischemic events, detected by continuous 12-lead ECG ST monitoring, early in the course of NSTACS, may add prognostic information to the TIMI-RS. Methods: In all, 567 consecutive patients with a NSTACS underwent 24-h continuous 12-lead ECG ST monitoring. An ST ischemic event was defined as a transient ST shift in any lead of , 0.10 mV compared with the reference ECG, lasting for ,l min. Results: The incidence of the composite of death, nonfatal myocardial infarction (or reinfarction) and recurrent ischemia by Day 14 was 22.2%. By Day 30, the incidence of the composite of death and nonfatal myocardial infarction (or reinfarction) was 14.7%. There was a significantly increased risk of 14-day (p value for trend < 0.001) or 30-day (p value for trend <0.001) composite endpoint with increasing of TIMI-RS. Moreover, the occurrence of , 1 ST shifts during ST monitoring was associated with a significantly increased risk of 14-(p value < 0.001) or 30-day (p value < 0.001) composite end-point, and this was true throughout the groups of TIMI-RS. Conclusions: The present study suggests that continuous 12-lead ECG ST monitoring, early in the course of NSTACS, may serve as an affordable tool to add prognostic information to the TIMI-RS. [source]


Therapeutic strategies, immediate and mid-term outcomes in non-ST-segment elevation acute coronary syndromes with respect to age: A single-center registry of 488 consecutive patients

CLINICAL CARDIOLOGY, Issue 8 2004
Mario Leoncini M.D.
Abstract Background: Elderly patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) may receive benefit from an early invasive strategy. However, aged patients often suffer from comorbidities that may contraindicate an invasive approach and affect prognosis adversely. The impact of comorbidities on an invasive approach to NSTE-ACS in the elderly has not been fully investigated. Hypothesis: This study sought to examine the outcome of an unselected population of patients with NSTE-ACS stratified according to age and treatment approach. Methods: The feasibility and efficacy of an invasive strategy for NSTE-ACS and the 6-month outcome were assessed in 253 unselected consecutive patients , 70 years (elderly) and compared with those of 235 unselected consecutive patients < 70 years. Results: Angiography was not performed in 69 patients (86% , 70 years) because of contraindications. In the whole population, the 6-month event rate was significantly higher in elderly compared with younger patients (22 vs. 14%; odds ratio 1.8, 95% confidence interval 1.1-2.9; p<0.02). This difference was driven by the high event rate observed in the elderly with contraindications to angiography (47 vs. 16% in the elderly treated invasively; p < 0.002). On the other hand, no significant difference was observed in the 6-month event rate between elderly and younger patients undergoing an invasive approach (16 vs. 13%; p=0.36). Contraindications to angiography,namely, creatinine , 1.5 mg/dl and elevated troponin I at admission,were the only independent predictors of 6-month outcome. Conclusions: The invasive approach was feasible in 77% of patients , 70 years. Those with contraindications to angiography showed a poor mid-term prognosis. The early invasive strategy was associated with more favorable outcomes regardless of age. [source]