1,721,322 research outputs found
Risk stratification in Acute Coronary Syndrome. Focus on UA/NSTEMI.
No full textAlthough there have been advances in the management of unstable angina/non-ST segment elevation myocardial infarction syndromes, the rate of cardiovascular mortality after discharge is still unacceptably high. With many therapeutic options available, the clinician is challenged to identify the safest and most effective treatment for long term survival of each individual patient
Normal coronary arteries: clinical implications and further classification.
No full textThe term "chest pain with normal coronary arteries" encompasses a large number of different cardiac pathophysiological abnormalities, including impairment of coronary flow reserve, endothelial dysfunction, and early atherosclerosis that, in most cases, cannot be readily differentiated one from the other. To study early coronary atherosclerosis, physicians must look beyond contrast filled arteries (so called lumenology). Angiograms cannot evaluate the vessel wall, plaque distribution and composition or other morphology. Plaques are often angiographically not visible due to their small size and compensatory enlargement (outward remodeling) of the coronary arteries. As a result, the search for an underlying atherosclerotic process remains ongoing. Available clinical studies showed that many patients with chest pain and normal angiography have early atherosclerosis as documented by intravascular ultrasound imaging, reduced coronary flow reserve and coronary endothelial dysfunction. Additional studies showed that patients presenting with normal coronary angiography have recurrent coronary events at long-term follow up. Research to determine if improved diagnosis and treatment of quantitatively low degrees of atherosclerosis lead to improved outcomes of patients with normal angiography should be undertaken
Coronary Microcirculation and Ischemic Heart Disease, Today
No full textThis article summarizes several contributions on the coronary microcirculation. Many of the participant authors belong to the Working Group on Coronary Pathophysiology and Microcirculation of European Society of Cardiology. These contributions explored a variety of topics pertaining to coronary microvascular physiology and pathophysiology. The latest methodologies that are being used to investigate the coronary microvasculature, including myocardial contrast echocardiography, fractional flow reserve and and instantaneous wave free ratio, are discussed. Advances in the mechanisms of dysfunction of the coronary microcirculation-for example, enhanced arginase activity and production of free radicals by dyslipidemia or hyperhomocysteinemia and its myogenic and flow-dependent responses--are reported. The articles touched on the relation of the microcirculation to clinically important conditions, such as the coronary no reflow phenomenon and offered recommendations for future research in important areas, such as angiogenesis and restoration of the microvascular network. This research is providing new ways to explore abnormalities of myocardial perfusion and its relationship with post infarction myocardial damage, an area of inquiry that until recently has been limited to examination of coronary pressure-flow relationships using doppler wire-based measure
Barriers to risk stratification accuracy in ischemic heart disease in women: the role of non-obstructive coronary artery disease
No full textBackground: A substantial part of literature has been centered on sex differences in the clinical aspects of ischemic heart disease (IHD). Many reports have documented differences in the presentation and risk profile between women and men. Such differences drive sex-related inequalities in the referral and treatment of IHD. Yet data are insufficient to clarify the reasons for such disparities. The objective of this review is to analyze the main gender differences regarding symptoms, diagnosis, and risk stratification of coronary heart disease in order to identify “gaps” in existing literature that need to be addressed in future research efforts. Methods: We searched English-language studies on MEDLINE and the Cochrane Database of Systematic Reviews from the database start dates to January 2016. Evidence synthesis was based on cohort studies, registry data, and clinical trial data. Results: Women do not often participate in clinical studies. In a number of articles, authors have questioned how the "white male” came to be the prototype of the human research subject. Consequently although many reports continue to describe differential treatment based on patients’ sex, the extent to which such inequalities are due to true sex differences in pathophysiology or whether they reflects inaccuracy in risk stratification is unclear. Conclusion: Today, even the best database is incapable in and of itself of supplying answers to the question of whether women are being treated less compared with men by the medical community
The International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC): 2010–2015
No full textBackground Central and East European (CEE) patients with acute coronary syndromes (ACS) have worse outcomes than US and West European patients, including higher mortality rates. The aim of the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) was to define patient and treatment characteristics in order to examine whether differences in clinical and ethnic factors or healthcare organization may mediate the observed disparities in outcomes. Methods and results Between October 2010 and December 2015, 14,326 patients with ACS were prospectively enrolled. Of these patients 8650 (60%) had ST-segment elevation myocardial infarction (STEMI). Patients were enrolled from 41 centers in 12 countries in Europe. Standardized electronic case report forms were completed by trained study coordinators, and included fields relating to demographic factors, medical history and processes of inpatient care, supplemented with a detailed baseline interview on time delays to hospital admission. Blood sampling for genetic data were obtained at hospital discharge. Prospective individual patient follow-up was carried out with a focus on patient health (symptoms) and vital status. Thirty day follow-up was 100% complete. Difficulties were found for recruitment of patients at 6 months. Publications are available at ClinicalTrials.gov: NCT01218776. Conclusions ISACS-TC is a novel ACS registry with detailed information on CEE patients' clinical, demographic, treatment, and metabolic characteristics and health status. The concurrent enrollment of patients from some European Union founding members provides greater generalizability of the data. ISACS-TC may help to make an additional improvement in clinical outcomes of countries with economy in transition
Vasotonic Angina as a Cause of Myocardial Ischemia in Women
No full textThe frequency, presentation, prognosis, and treatment of myocardial ischemia differ in men and women. A large proportion of women who have “normal” coronary arteries on angiography without any significant evidence of flow-limiting disease also have biochemical or imaging evidence of myocardial ischemia. In these women it is believed to be a dysfunction of coronary microcirculation and/or macrocirculation, or vasotonic angina (VA), that leads to abnormal vasoconstriction, and potentially to myocardial infarction, ventricular arrhythmias, and sudden death. Despite having a “normal” or near normal coronary angiography, these women should therefore undergo additional testing with acetylcholine to assess endothelial function. Long-term survival is believed to be relatively good. Predictors of poorer prognosis include documentation of severe endothelial dysfunction and presence of concurrent angiographycally visible coronary atherosclerosis. Because atherosclerosis is common in patients with VA, medical and lifestyle interventions for preventing or treating atherosclerosis should be implemented when appropriate. Angiotensin converting enzyme inhibitors are the mainstays of medical therapy for VA. Other agents have been tried with variable success, including beta-blockers. There are no available data on any specific treatment of VA in women (versus men)
Angina with "normal" coronary arteries: a changing philosophy
No full textContext: Many women with angina are told that they have no significant heart disease following demonstration of normal or near-normal coronary arteries and are offered no specific treatment beyond reassurance. Evidence Acquisition: MEDLINE and the Cochrane Database of Systematic Reviews were searched from their start dates until June 2004 for analysis using specific key words including diagnosis and therapy of angina with normal angiography and angina with normal coronary arteries. Reference lists of published articles and data of meeting presentations were also consulted. Evidence Synthesis: Normal or nonobstructive coronary disease at angiography is not uncommon and occurs in 10% of women presenting with ST-segment elevation myocardial infarction compared with 6% in men. Patients with evidence of myocardial ischemia or myocardial infarction and nonobstructive atherosclerotic disease of the coronary arteries are more likely to be women and nonwhite. Symptoms are often indistinguishable from those with obstructive coronary artery disease. The prognosis of patients with unstable angina and nonobstructive atherosclerotic coronary artery disease is not benign and includes a 2% risk of death or myocardial infarction at 30 days of follow-up. Recent work has shown that at least 20% of women with normal or nonobstructive angiography have myocardial ischemia, likely due to atherosclerosis-related endothelial dysfunction, which itself is associated with an increased risk of later adverse cardiac events and development of frank future obstructive disease. Randomized placebo-controlled studies have demonstrated that tricyclic antidepressants, β-blockers, angiotensin-converting enzyme inhibitors, L-arginine, statins, and exercise may relieve symptoms, vascular dysfunction, or both; however, longer-term studies evaluating cardiac event rates need to be performed. Conclusions: Patients with chest pain and normal or nonobstructive coronary angiograms are predominantly women, and many have a prognosis that is not as benign as commonly thought. Assessment of endothelial function may help identify patients at risk for future cardiac events. Therapy should be directed at symptom relief with tricyclic agents and β-blockers, and aggressive antiatherosclerotic therapy with statins, angiotensin-converting enzyme inhibitors, or both should be applied when risk factors are present or prognostic risk is high. Large-scale randomized trials need to be conducted to determine optimal ways of preventing clinical events
Big data: a new look at old problems
No full textThe term Big Data is an elusive term with a definition that is not commonly agreed upon. According to a recent definition, the term would encompass any data that is around a petabyte (1015 bytes) or more in size. In health informatics research, Big Data of this size is quite rare. Nevertheless, data used for health informatics research can be considered Big Data in terms of their richness of clinical information and complex structure and may represent an important source of information relevant to the clinical decision-making in real-world patient settings
- …
