Risk stratification

Risk stratification multilead continuous ST-segment monitoring obtain serial troponin and CK MB... 

Risk-stratification of the patient with NSTE ACS is more complex, as in-hospital outcomes for this group of patients varies with reported rates of death of 0% to 12%, reinfarction rates of 0% to 3%, and recurrent severe ischemia rates of 5% to 20%.12 Not all patients presenting with suspected NSTE ACS will even have CAD. Some will eventually be diagnosed with non-ischemic chest discomfort. In general, among NSTE patients, those with ST-segment depression (Fig. 5-1) and/or elevated troponin and/or CK-MB are at higher risk of death or recurrent infarction. 

Sethi S, Murphy TF. Acute exacerbations of chronic bronchitis new developments concerning microbiology and pathophysiology— impact on approaches to risk stratification and therapy. Infect Dis Clin North Am 2004 18 861-882. 

The goal of antimicrobial prophylaxis in dental procedures is to prevent endocarditis. According to American Heart Association guidelines, at-risk individuals should receive 2 g of amoxicillin 1 hour prior to the procedure.23 Patients with a (5-lactam allergy may receive clindamycin 600 mg 1 hour prior to the procedure. Interested readers should refer to the American Heart Association guidelines for a complete discussion on risk stratification and recommendations. 

Intermediate to high probability of coronary artery disease -High risk CAD unlikely -Risk stratification complete or not required... 

Recommendations of the Second Princeton Consensus Conference for Cardiovascular Risk Stratification of Patients Being Considered for Phosphodiesterase Inhibitor Therapy... 

Investigative efforts are underway to further improve the results of multimodality therapy of colorectal carcinoma. In addition to previously discussed phase III trials, other studies are incorporating novel chemotherapeutic agents to improve systemic control and radiosensitization, optimizing physical delivery of radiation, and performing risk stratification with current molecular and genetic techniques. 

For patients with chronic CAD, nuclear imaging is essential for addressing the following major clinical issues (i) detection of ischemic myocardium, (ii) differentiation between viable hibernating or stunned myocardium and scar tissue in mechanically dysfunctional regions, and (ill) risk stratification for future major adverse events. Such information provides the basis for percutaneous coronary intervention (PCI) or coronary artery bypass (CAB) surgery and assessing their outcomes based on detection of residual ischemia and recovery of contractile function. 

Andresen D, Steinbeck G, Bruggemann T, et al. Risk stratification following myocardial infarction in the thrombolytic era a two-step strategy using noninvasive and invasive methods. J Am Coll Cardiol. Jan... 

Table 1. Components of cardiovascular risk stratification (adapted from Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, 2003)...

Acute lymphoblastic leukemia is the most common childhood cancer with cure rates of approximately 80% of all patients (1). This success rate largely stems from collaborative clinical trials that have developed risk stratification groups. Treatment intensity is proportional to relapse risk, with patients at relapse risks receiving more intensive, and therefore toxic, therapy. Thus, the overall goal of risk stratification is to balance successful treatment against toxicity. 

While substantial improvements have been made in risk stratification, current risk stratification algorithms still fail to identify prospectively the 20% of patients at risk for relapse. Likewise, these risk stratification methods imperfectly predict treatment toxic-ities, particularly less common or dose independent ones. The use of germline genetic data in risk stratification procedures has the potential to improve risk prediction and may ultimately allow for even more individualized treatment choices. 

Span, P.N., Sweep, F.C., Wiegerinck, E.T., Tjan-Heijnen, V.C., Manders, P., Beex, L.V., and de Kok, J.B. 2004. Survivin is an independent prognostic marker for risk stratification of breast cancer patients. Clin. Chem. 50, 1986-1993. 

Pollack CV, Peacock WF, Summers RW, et al. Ischemia-modified albumin (IMA) is useful in risk stratification of emergency department chest pain patients. Acad Emerg Med 2003 10 555-556. 

B5. Barrans, S. L., Carter, I., Owen, R. G., Davies, F. E., Patmore, R. D., Haynes, A. P., Morgan, G. L, and Jack, A. S., Germinal center phenotype and bcl-2 expression combined with the International Prognostic Index improves patient risk stratification in diffuse large B-cell lymphoma. Blood 99,1136-1143 (2002). 

Sabatine MS, Morrow DA, de Lemos JA, et al. Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes. Circulation 2002 105 1760-1763. 

Heeschen C, Hamm CW, MhrovicV etal. N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients with acute coronary syndromes. Circulation 2004 ... 

Bartholomew BA, Harjai KJ, Dukkipati S, et al. Impact of nephropathy after percutaneous coronary intervention and a method for risk stratification. Am J Cardiol 2004 93 1515-1519. 

The Second Princeton Consensus on Sexual Function concluded that the recognition of ED as a warning sign of silent vascular disease has led to the concept that a man with ED and no cardiac symptoms is a cardiac (or vascular) patient until proved otherwise, Therefore any asymptomatic man who presents with ED that does not have an obvious cause (e.g., trauma) should be screened for vascular disease and have blood glucose, lipids, and BP measured. Ideally, all patients at risk should undergo an elective exercise ECG to facilitate risk stratification (3 1,32). 

TIA-related infarctions on DWI can be predicted on the basis of certain clinical TIA features. Transient motor symptoms, preceding non-stereotypic attacks, the presence of an established cause of stroke, and presentation with aphasia are independent predictors of infarction on DWI (Ay et al. 2002 Crisostomo et al. 2003). In contrast, limb paresthesias, slurred speech, and brief attacks of dizziness or imbalance are not associated with occurrence of infarction. Of note, most symptoms that are not associated with infarction on DWI are based on patients subjective feelings and sensations in contrast to motor deficit or aphasia, it is not possible to objectively assess such symptoms and mark the brain as their origin. Of particular relevance to this point is that, according to a recent study, the independent predictors of infarction on DWI such as motor deficit and speech impairment are also independently associated with increased risk of stroke after TIA (Johnston et al. 2003), suggesting a potential role for DWI in the risk stratification for stroke following TIA. 

The ideal marker of myocardial injury should (1) provide early detection of injury, (2) allow rapid diagnosis of cardiac injury, (3) serve as a risk stratification tool in patients with ACS, (4) assess the success of reperfusion after thrombolytic therapy, (5) detect reocclusion and reinfarction, (6) determine the timing of an infarction as well as infarct size, and (7) detect procedural-related perioperative MI during cardiac or noncardiac surgery. At present, the perfect biomarker to satisfy all these needs does not exist. It is the function of the laboratory to provide advice to physicians about cardiac biomarker characteristics. 

Numerous prospective and retrospective clinical studies have evaluated and compared the utility of measurements of cTnl and cTnT for risk stratification or clinical outcomes assessment of patients with ACS with possible myocardial... 

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