Ischemia-Guided Management Using Cardiac SPECT: Reconciling Real-World Evidence in a Post-ISCHEMIA Trial World.

Circ Cardiovasc Imaging

Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT (D.J.H.).

Published: September 2024

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11408079PMC
http://dx.doi.org/10.1161/CIRCIMAGING.124.017377DOI Listing

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Article Synopsis
  • Acute coronary syndrome (ACS) remains a major global health threat, prompting a study in Palestine that evaluated treatment strategies and risk factors among 255 patients diagnosed with ACS in a hospital setting.
  • The study found that 71% of patients were male, with common risk factors including smoking, diabetes, and hypertension; unstable angina was the most frequent type of ACS.
  • Results indicated the prevalent use of ischemia-guided treatment strategies, adherence to clinical guidelines, and emphasized the need for increased awareness of cardiovascular disease risk factors to improve health outcomes.
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Objective: Patients undergoing vascular surgery procedures have poor long-term survival due to coexisting coronary artery disease (CAD), which is often asymptomatic, undiagnosed, and undertreated. We sought to determine whether preoperative diagnosis of asymptomatic (silent) coronary ischemia using coronary computed tomography (CT)-derived fractional flow reserve (FFR) together with postoperative ischemia-targeted coronary revascularization can reduce adverse cardiac events and improve long-term survival following major vascular surgery METHODS: In this observational cohort study of 522 patients with no known CAD undergoing elective carotid, peripheral, or aneurysm surgery we compared two groups of patients. Group I included 288 patients enrolled in a prospective Institutional Review Board-approved study of preoperative coronary CT angiography (CTA) and FFR testing to detect silent coronary ischemia with selective postoperative coronary revascularization in addition to best medical therapy (BMT) (FFR guided), and Group II included 234 matched controls with standard preoperative cardiac evaluation and postoperative BMT alone with no elective coronary revascularization (Usual Care).

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Regardless of early invasive or ischemia-guided approaches to non-ST segment elevation myocardial infarction (NSTEMI) management, P2Y 12 inhibitors remain the backbone in therapy. The ideal timing of administration remains unclear. The purpose of this study was to determine the safety and effectiveness of early versus late administration of P2Y 12 inhibitors in patients presenting with an NSTEMI who go to the catheterization laboratory beyond 24 hours from presentation.

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Challenges and Controversies in the Management of ACS in Elderly Patients.

Curr Cardiol Rep

June 2020

Section of Cardiology, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.

Purpose Of Review: Elderly patients presenting with acute coronary syndrome (ACS) represent a challenging patient population. A high index of suspicion is needed for their diagnosis, as they are less likely to present with typical anginal symptoms compared to their younger counterparts.

Recent Findings: Disrupted coronary plaques with superimposed thrombosis are the predominant pathophysiology of ACS; however, an increased proportion of calcified nodules is encountered in elderly patients.

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