Chest pain interventions: Difference between revisions
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==Overview== | ==Overview== | ||
Common indications of [[coronary angiography]] in high risk [[ACS]] [[patients]] include new [[ischemic]] changes on the [[ECG]] | |||
, [[troponin]]-confirmed acute [[myocardial injury]] | |||
, new-onset [[left ventricular systolic dysfunction ]] ([[ejection fraction]] <40%) | |||
, newly diagnosed moderate-severe [[ischemia]] on [[stress]] imaging. For high-risk [[patients]] presented with documented [[AMI]] and normal [[epicardial coronary arteries]] on [[CCTA]] or invasive [[ coronary angiography]], or nonobstructive [[CAD]], [[CMR]] and [[echocardiography]] are useful for evaluation of [[nonischemic cardiomyopathy]] or [[myocarditis]]. Among high risk [[patients]], [[invasive coronary angiography]] provides a comprehensive assessment of the extent and severity of obstructive [[CAD]]. The determination of the severity of anatomic [[CAD]] is critical to guide the use of [[coronary revascularization]]. Approximately 6% to 15% of [[troponin]]-positive [[ACS]] occurs in the absence of obstructive [[CAD]]. Additional testing may be helpful to determine the strategy of treatment. Evidence supports that [[CMR]] can identify [[wall motion abnormalities]] and [[myocardial edema]] and distinguish [[infarct]]-related [[scar]] from non-[[CAD]] causes such as [[myocarditis]] and [[nonischemic cardiomyopathy]]. Performing [[CMR]] within 2 weeks of [[ACS]], can be useful to identify [[MI ]] with nonobstructive [[CAD]] ([[MINOCA]]) from other causes. The term obstructive [[CAD]] indicates [[CAD]] with ≥50% stenosis. Nonobstructive [[CAD]] is used if [[CAD]] <50% stenosis. High risk [[CAD]] is defined in the presence of obstructive [[stenosis]] with [[left main]] stenosis ≥50% or anatomically significant 3-vessel disease (≥70% stenosis). | |||
==Indications== | ==Indications== | ||
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*::For high-risk [[patients]] presented with documented [[AMI]] and normal [[epicardial coronary arteries]] on [[CCTA]] or invasive [[ coronary angiography]], or nonobstructive [[CAD]], [[CMR]] and [[echocardiography]] are useful for evaluation of [[nonischemic cardiomyopathy]] or [[myocarditis]]. | *::For high-risk [[patients]] presented with documented [[AMI]] and normal [[epicardial coronary arteries]] on [[CCTA]] or invasive [[ coronary angiography]], or nonobstructive [[CAD]], [[CMR]] and [[echocardiography]] are useful for evaluation of [[nonischemic cardiomyopathy]] or [[myocarditis]]. | ||
* Among high risk [[patients]], [[invasive coronary angiography]] provides a comprehensive assessment of the extent and severity of obstructive [[CAD]]. | * Among high risk [[patients]], [[invasive coronary angiography]] provides a comprehensive assessment of the extent and severity of obstructive [[CAD]]. | ||
*The determination of the severity of anatomic [[CAD]] is critical to guide the use of [[coronary revascularization]]. *Approximately 6% to 15% of [[troponin]]-positive [[ACS ]] occurs in the absence of obstructive [[CAD]]. | *The determination of the severity of anatomic [[CAD]] is critical to guide the use of [[coronary revascularization]]. | ||
* Additional testing may be helpful to | * Approximately 6% to 15% of [[troponin]]-positive [[ACS]] occurs in the absence of obstructive [[CAD]]. | ||
* Additional testing may be helpful to determine the strategy of treatment. | |||
*Evidence supports that [[CMR]] can identify [[wall motion abnormalities]] and [[myocardial edema]] and distinguish [[infarct]]-related [[scar]] from non-[[CAD]] causes such as [[myocarditis]] and [[nonischemic cardiomyopathy]]. | *Evidence supports that [[CMR]] can identify [[wall motion abnormalities]] and [[myocardial edema]] and distinguish [[infarct]]-related [[scar]] from non-[[CAD]] causes such as [[myocarditis]] and [[nonischemic cardiomyopathy]]. | ||
*Performing [[CMR]] within 2 weeks of [[ACS]], can be useful to identify [[MI ]] with nonobstructive [[CAD]] ([[MINOCA]]) from other causes. | *Performing [[CMR]] within 2 weeks of [[ACS]], can be useful to identify [[MI ]] with nonobstructive [[CAD]] ([[MINOCA]]) from other causes. | ||
*The term obstructive [[CAD]] indicates [[CAD]] with ≥50% stenosis. | |||
* Nonobstructive [[CAD]] is used if [[CAD]] <50% stenosis. | |||
* | * High risk [[CAD]] is defined in the presence of obstructive [[stenosis]] with [[left main]] stenosis ≥50% or anatomically significant 3-vessel disease (≥70% stenosis. | ||
* [[ | |||
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==References== | ==References== | ||
Latest revision as of 09:53, 18 January 2022
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Chest pain Microchapters |
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Chest pain interventions On the Web |
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Risk calculators and risk factors for Chest pain interventions |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Aisha Adigun, B.Sc., M.D.[3]
Overview
Common indications of coronary angiography in high risk ACS patients include new ischemic changes on the ECG , troponin-confirmed acute myocardial injury , new-onset left ventricular systolic dysfunction (ejection fraction <40%) , newly diagnosed moderate-severe ischemia on stress imaging. For high-risk patients presented with documented AMI and normal epicardial coronary arteries on CCTA or invasive coronary angiography, or nonobstructive CAD, CMR and echocardiography are useful for evaluation of nonischemic cardiomyopathy or myocarditis. Among high risk patients, invasive coronary angiography provides a comprehensive assessment of the extent and severity of obstructive CAD. The determination of the severity of anatomic CAD is critical to guide the use of coronary revascularization. Approximately 6% to 15% of troponin-positive ACS occurs in the absence of obstructive CAD. Additional testing may be helpful to determine the strategy of treatment. Evidence supports that CMR can identify wall motion abnormalities and myocardial edema and distinguish infarct-related scar from non-CAD causes such as myocarditis and nonischemic cardiomyopathy. Performing CMR within 2 weeks of ACS, can be useful to identify MI with nonobstructive CAD (MINOCA) from other causes. The term obstructive CAD indicates CAD with ≥50% stenosis. Nonobstructive CAD is used if CAD <50% stenosis. High risk CAD is defined in the presence of obstructive stenosis with left main stenosis ≥50% or anatomically significant 3-vessel disease (≥70% stenosis).
Indications
Common indications of coronary angiography in high risk ACS patients include:
- New ischemic changes on the ECG
- Troponin-confirmed acute myocardial injury
- New-onset left ventricular systolic dysfunction (ejection fraction <40%)
- Newly diagnosed moderate-severe ischemia on stress imaging
- For high-risk patients presented with documented AMI and normal epicardial coronary arteries on CCTA or invasive coronary angiography, or nonobstructive CAD, CMR and echocardiography are useful for evaluation of nonischemic cardiomyopathy or myocarditis.
- Among high risk patients, invasive coronary angiography provides a comprehensive assessment of the extent and severity of obstructive CAD.
- The determination of the severity of anatomic CAD is critical to guide the use of coronary revascularization.
- Approximately 6% to 15% of troponin-positive ACS occurs in the absence of obstructive CAD.
- Additional testing may be helpful to determine the strategy of treatment.
- Evidence supports that CMR can identify wall motion abnormalities and myocardial edema and distinguish infarct-related scar from non-CAD causes such as myocarditis and nonischemic cardiomyopathy.
- Performing CMR within 2 weeks of ACS, can be useful to identify MI with nonobstructive CAD (MINOCA) from other causes.
- The term obstructive CAD indicates CAD with ≥50% stenosis.
- Nonobstructive CAD is used if CAD <50% stenosis.
- High risk CAD is defined in the presence of obstructive stenosis with left main stenosis ≥50% or anatomically significant 3-vessel disease (≥70% stenosis.