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6. Safety and Efficacy of Switching From Either Unfractionated Heparin or Enoxaparin to Bivalirudin in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Managed With an Invasive Strategy: Results From the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial

Author

White, Harvey D., Chew, Derek P., Hoekstra, James W., Miller, Chadwick D., Pollack, Charles V., Jr, Feit, Frederick, Lincoff, A. Michael, Bertrand, Michel, Pocock, Stuart, Ware, James, Ohman, E. Magnus, Mehran, Roxana, and Stone, Gregg W.

Published
2008
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9. Timing of Glycoprotein IIb/IIIa Inhibitor Use and Outcomes Among Patients With Non–ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention (Results from CRUSADE)

Author

Tricoci, Pierluigi, Peterson, Eric D., Chen, Anita Y., Newby, L. Kristin, Harrington, Robert A., Greenbaum, Adam B., Cannon, Chistopher P., Gibson, C. Michael, Hoekstra, James W., Pollack, Charles V., Jr., Ohman, E. Magnus, Gibler, W. Brian, and Roe, Matthew T.

Published
2007
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11. Standardized Reporting Guidelines for Studies Evaluating Risk Stratification of Emergency Department Patients With Potential Acute Coronary Syndromes

Author

Hollander, Judd E., Blomkalns, Andra L., Brogan, Gerard X., Diercks, Deborah B., Field, John M., Lee Garvey, J., Gibler, W. Brian, Henry, Timothy D., Hoekstra, James W., Holroyd, Brian R., Hong, Yuling, Kirk, J. Douglas, OʼNeil, Brian J., Jackson, Raymond E., Hollander, Judd E., Aufderheide, Tom, Blomkalns, Andra L., Brogan, Gerard X., Christenson, James, Collins, Sean, Diercks, Deborah B., Fesmire, Francis M., Lee Garvey, J., Gibler, W. Brian, Green, Gary B., Hoekstra, James W., Holroyd, Brian R., Kirk, J. Douglas, Lindsell, Christopher J., Peacock, W. Frank, IV, Pollack, Charles V., Zalenski, Robert, and Jackson, Raymond E.

Published
2004

13. A randomized, placebo-controlled trial of early eptifibatide for non-ST-segment elevation acute coronary syndromes

Author

Roe, Matthew T., Christenson, Robert H., Ohman, Magnus, Bahr, Raymond, Fesmire, Francis M., Storrow Alan, Mollod, Michael, Peacock, Frank W., Rosenblatt, Jeffrey A., Hongqiu Yang, Fraulo, Elizabeth S., Hoekstra, James W., and Gibler, Brian W.

Subjects
Myocardial ischemia -- Research, Myocardial ischemia -- Care and treatment, Cardiac patients -- Research, Cardiac patients -- Care and treatment, Placebos -- Research, Health
Published
2003

15. The Internet Tracking Registry of Acute Coronary Syndromes (i*tr ACS): A Multicenter Registry of Patients With Suspicion of Acute Coronary Syndromes Reported Using the Standardized Reporting Guidelines for Emergency Department Chest Pain Studies

Author

Lindsell, Christopher J., Anantharaman, Venkataraman, Diercks, Deborah, Han, Jin Ho, Hoekstra, James W., Hollander, Judd E., Kirk, J. Douglas, Lim, Swee-Han, Peacock, W. Frank, Tiffany, Brian, Wilke, Eric K., Gibler, W. Brian, and Pollack, Charles V., Jr

Published
2006
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17. The impact of emergency department structure and care processes in delivering care for non–ST-segment elevation acute coronary syndromes

Author

Mehta, Rajendra H., Newby, L. Kristin, Patel, Yogin, Hoekstra, James W., Miller, Chadwick D., Chen, Anita Y., Lytle, Barbara L., Diercks, Deborah B., Summers, Richard L., Brogan, Gerard X., Peacock, W. Frank, Pollack, Charles V., Jr, Roe, Matthew T., Peterson, Eric D., Ohman, E. Magnus, and Gibler, W. Brian

Published
2006
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24. Implementation of a Statewide System for Coronary Reperfusion for ST-Segment Elevation Myocardial Infarction

Author

Jollis, James G., Roettig, Mayme L., Aluko, Akinyele O., Anstrom, Kevin J., Applegate, Robert J., Babb, Joseph D., Berger, Peter B., Bohle, David J., Fletcher, Sidney M., Garvey, J. Lee, Hathaway, William R., Hoekstra, James W., Kelly, Robert V., Maddox, William T., Jr, Shiber, Joseph R., Valeri, F. Scott, Watling, Bradley A., Wilson, B. Hadley, and Granger, Christopher B.

Published
2007

26. Impact of Acute Beta-Blocker Therapy for Patients with Non-ST-Segment Elevation Myocardial Infarction

Author

Miller, Chadwick D., Roe, Matthew T., Mulgund, Jyotsna, Hoekstra, James W., Santos, Renato, Pollack, Charles V., Ohman, E. Magnus, Gibler, W. Brian, and Peterson, Eric D.

Subjects
Adrenergic beta blockers -- Research, Heart attack -- Research, Heart attack -- Care and treatment, Heart attack -- Patient outcomes, Health, Health care industry
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2007.04.016 Byline: Chadwick D. Miller (a), Matthew T. Roe (b), Jyotsna Mulgund (b), James W. Hoekstra (a), Renato Santos (a), Charles V. Pollack (c), E. Magnus Ohman (b), W. Brian Gibler (d), Eric D. Peterson (b) Keywords: Acute coronary syndromes; Beta blockers; Guidelines; Patient care Abstract: Early use of beta-blockers is a quality indicator for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI), despite limited data from randomized clinical trials in this population. We sought to determine the impact of acute beta-blocker therapy on outcomes in patients with NSTEMI. Author Affiliation: (a) Wake Forest University Health Sciences, Winston-Salem, NC (b) Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (c) Pennsylvania Hospital, University of Pennsylvania School of Medicine, Philadelphia (d) University of Cincinnati College of Medicine, Cincinnati, Ohio. Article Note: (footnote) CRUSADE is funded by the Schering-Plough Corporation. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides additional funding support. Millennium Pharmaceuticals, Inc. also funded this work.

Published
2007

28. The internet tracking registry of acute coronary syndromes (i*trACS): a multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies

Author

Lindsell, Christopher J., Anantharaman, Venkataraman, Diercks, Deborah, Han, Jin Ho, Hoekstra, James W., Hollander, Judd E., Kirk, J. Douglas, Lim, Swee-Han, Peacock, W. Frank, Tiffany, Brian, Wilke, Eric K., Gibler, W. Brian, and Pollack, Charles V., Jr.

Subjects
Chest pain -- Research, Internet -- Usage, Emergency medicine -- Technology application, Internet, Technology application, Health
Published
2006

30. Standardized reporting guidelines for studies evaluating risk stratification of emergency department patients with potential acute coronary syndromes

Author

Multidisciplinary Standardized Reporting Criteria Task Force, Hollander, Judd E., Blomkalns, Andra L., Brogan, Gerard X., Diercks, Deborah B., Field, John M., Garvey, J. Lee, Gibler, W. Brian, Henry, Timothy D., Hoekstra, James W., Holroyd, Brian R., Hong, Yuling, Kirk, J. Douglas, O'Neil, Brian J., Jackson, Raymond E., Standardized Reporting Criteria Working Group of Emergency Medicine Cardiac Research and Education Group–International Members, Aufderheide, Tom, Christenson, James, Collins, Sean, Fesmire, Francis M., Green, Gary B., Lindsell, Christopher J., Peacock, W. Frank, IV, Pollack, Charles V., and Zalenski, Robert

Published
2004
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35. Thrombolytic therapy: how best to use in acute MI

Author

Riviello, Ralph J. and Hoekstra, James W.

Subjects
Thrombolytic therapy -- Evaluation, Heart attack -- Drug therapy, Streptokinase -- Evaluation, Tissue plasminogen activator -- Evaluation, Anistreplase -- Evaluation, Health, Drug therapy, Evaluation
Abstract

Each year, approximately 1.5 million Americans suffer a myocardial infarction (MI); nearly 500,000 of them die as a result. Most of these deaths occur soon after symptom onset and well [...]

Published
1998

37. The HEART Pathway Randomized Controlled Trial One‐year Outcomes

Author

Stopyra, Jason P., primary, Riley, Robert F., additional, Hiestand, Brian C., additional, Russell, Gregory B., additional, Hoekstra, James W., additional, Lefebvre, Cedric W., additional, Nicks, Bret A., additional, Cline, David M., additional, Askew, Kim L., additional, Elliott, Stephanie B., additional, Herrington, David M., additional, Burke, Gregory L., additional, Miller, Chadwick D., additional, and Mahler, Simon A., additional

Published
2018
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38. Impact of anticoagulation regimen prior to revascularization in patients with non-ST-segment elevation acute coronary syndromes:The ACUITY trial

Author

Geisler, Tobias, Droppa, Michal, Gawaz, Meinrad, Steinhubl, Steven R, Bertrand, Michel E, Lincoff, A Michael, Cequier, Angel R, Desmet, Walter, Rasmussen, Lars H, Hoekstra, James W, Bernstein, Debra, Deliargyris, Efthymios N, Mehran, Roxana, and Stone, Gregg W

Abstract

AIM: To evaluate the impact of antithrombotic regimens during the medical phase of treatment among 13,819 patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) treated with an early invasive strategy in the acute catheterization and urgent intervention triage strategy (ACUITY) trial.METHODS AND RESULTS: Endpoints included composite major adverse cardiac events (MACE), major bleeding, and net adverse clinical events (NACE; MACE or major bleeding). The median (interquartile range) duration of antithrombin use in the medical only treatment phase was 6.5 (1.8-22.5) hours. MACE, major bleeding, and NACE during the medical only phase occurred in 63 (0.5%), 117 (0.9%), and 178 (1.3%) patients, respectively. MACE rates in the medical-treatment-only phase were not significantly different between the four randomized medical regimens used (heparin alone, bivalirudin alone, heparin plus a glycoprotein IIb/IIIa inhibitor [GPI], and bivalirudin plus GPI) (Ptrend = 0.65). The lowest rates of major bleeding and NACE during the medical treatment phase occurred in patients treated with bivalirudin alone (Ptrend = 0.0006 and Ptrend = 0.0004, respectively).CONCLUSIONS: In patients with NSTE-ACS undergoing an early invasive strategy, treatment with bivalirudin alone significantly reduced major bleeding and improved net clinical outcomes during the upstream medical management phase with comparable rates of MACE. © 2015 Wiley Periodicals, Inc.

Published
2016

39. The HEART Pathway Randomized Controlled Trial One‐year Outcomes.

Author

Stopyra, Jason P., Riley, Robert F., Hiestand, Brian C., Russell, Gregory B., Hoekstra, James W., Lefebvre, Cedric W., Nicks, Bret A., Cline, David M., Askew, Kim L., Elliott, Stephanie B., Herrington, David M., Burke, Gregory L., Miller, Chadwick D., Mahler, Simon A., and Diercks, Deborah B.

Subjects
CHEST pain diagnosis, CHEST pain treatment, ACUTE diseases, TROPONIN, CARDIAC arrest, CONFIDENCE intervals, CORONARY artery bypass, FISHER exact test, HOSPITAL care, HOSPITAL emergency services, MEDICAL appointments, MEDICAL care, MEDICAL care use, MYOCARDIAL infarction, MYOCARDIAL revascularization, PATIENTS, PATIENT safety, RISK assessment, PSYCHOLOGICAL stress, RANDOMIZED controlled trials, TREATMENT effectiveness, PREDICTIVE tests, CORONARY angiography, DIAGNOSIS, THERAPEUTICS
Abstract

Objective: The objective was to determine the impact of the HEART Pathway on health care utilization and safety outcomes at 1 year in patients with acute chest pain. Methods: Adult emergency department (ED) patients with chest pain (N = 282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, ED providers used the HEART score and troponin measures (0 and 3 hours) to risk stratify patients. Usual care was based on American College of Cardiology/American Heart Association guidelines. Major adverse cardiac events (MACE—cardiac death, myocardial infarction [MI], or coronary revascularization), objective testing (stress testing or coronary angiography), and cardiac hospitalizations and ED visits were assessed at 1 year. Randomization arm outcomes were compared using Fisher's exact tests. Results: A total of 282 patients were enrolled, with 141 randomized to each arm. MACE at 1 year occurred in 10.6% (30/282): 9.9% in the HEART Pathway arm (14/141; 10 MIs, four revascularizations without MI) versus 11.3% in usual care (16/141; one cardiac death, 13 MIs, two revascularizations without MI; p = 0.85). Among low‐risk HEART Pathway patients, 0% (0/66) had MACE, with a negative predictive value (NPV) of 100% (95% confidence interval = 93%–100%). Objective testing through 1 year occurred in 63.1% (89/141) of HEART Pathway patients compared to 71.6% (101/141) in usual care (p = 0.16). Nonindex cardiac‐related hospitalizations and ED visits occurred in 14.9% (21/141) and 21.3% (30/141) of patients in the HEART Pathway versus 10.6% (15/141) and 16.3% (23/141) in usual care (p = 0.37, p = 0.36). Conclusions: The HEART Pathway had a 100% NPV for 1‐year safety outcomes (MACE) without increasing downstream hospitalizations or ED visits. Reduction in 1‐year objective testing was not significant. [ABSTRACT FROM AUTHOR]

Published
2019
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41. Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome

Author

Sun, Benjamin C., primary, Laurie, Amber, additional, Fu, Rongwei, additional, Ferencik, Maros, additional, Shapiro, Michael, additional, Lindsell, Christopher J., additional, Diercks, Deborah, additional, Hoekstra, James W., additional, Hollander, Judd E., additional, Kirk, J. Douglas, additional, Peacock, W. Frank, additional, Gibler, W. Brian, additional, Anantharaman, Venkataraman, additional, and Pollack, Charles V., additional

Published
2016
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42. Chest Pain Risk Stratification

Author

Stopyra, Jason P., primary, Miller, Chadwick D., additional, Hiestand, Brian C., additional, Lefebvre, Cedric W., additional, Nicks, Bret A., additional, Cline, David M., additional, Askew, Kim L., additional, Riley, Robert F., additional, Russell, Gregory B., additional, Burke, Greg L., additional, Herrington, David, additional, Hoekstra, James W., additional, and Mahler, Simon A., additional

Published
2016
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43. Comparison of the HEART and TIMI Risk Scores for Suspected Acute Coronary Syndrome in the Emergency Department

Author

Sun, Benjamin C., primary, Laurie, Amber, additional, Fu, Rongwei, additional, Ferencik, Maros, additional, Shapiro, Michael, additional, Lindsell, Christopher J., additional, Diercks, Deborah, additional, Hoekstra, James W., additional, Hollander, Judd E., additional, Kirk, J. Douglas, additional, Peacock, W. Frank, additional, Anantharaman, Venkataraman, additional, and Pollack, Charles V., additional

Published
2016
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44. Adherence to an Accelerated Diagnostic Protocol for Chest Pain: Secondary Analysis of the HEART Pathway Randomized Trial

Author

Mahler, Simon A., primary, Riley, Robert F., additional, Russell, Gregory B., additional, Hiestand, Brian C., additional, Hoekstra, James W., additional, Lefebvre, Cedric W., additional, Nicks, Bret A., additional, Cline, David M., additional, Askew, Kim L., additional, Bringolf, John, additional, Elliott, Stephanie B., additional, Herrington, David M., additional, Burke, Gregory L., additional, and Miller, Chadwick D., additional

Published
2015
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46. Can the HEART Score Safely Reduce Stress Testing and Cardiac Imaging in Patients at Low Risk for Acute Coronary Syndrome?

Author

Mahler, Simon A., Hiestand, Brian C., Goff, David C., Hoekstra, James W., and Miller, Chadwick D.

Subjects
Male, Chest Pain, Incidence, Coronary Care Units, Reproducibility of Results, Middle Aged, Prognosis, Risk Assessment, Article, Diagnosis, Differential, Cardiac Imaging Techniques, Electrocardiography, Cross-Sectional Studies, Risk Factors, Confidence Intervals, Exercise Test, Odds Ratio, Humans, Female, Acute Coronary Syndrome, Aged, Follow-Up Studies, Retrospective Studies
Abstract

Patients with low-risk chest pain have high utilization of stress testing and cardiac imaging, but low rates of acute coronary syndrome (ACS). The objective of this study was to determine whether the HEART score could safely reduce objective cardiac testing in patients with low-risk chest pain.A cohort of chest pain patients was identified from an emergency department-based observation unit registry. HEART scores were determined using registry data elements and blinded chart review. HEART scores were dichotomized into low (0-3) or high risk (3). The outcome was major adverse cardiac events (MACE); a composite end point of all-cause mortality, myocardial infarction, or coronary revascularization during the index visit or within 30 days. Sensitivity, specificity, and potential reduction of cardiac testing were calculated.In a span of 28 months, the registry included 1070 low-risk chest pain patients. MACE occurred in 0.6% (5/904) of patients with low-risk HEART scores compared with 4.2% (7/166) with a high-risk HEART scores (odds ratio = 7.92; 95% confidence interval [95% CI]: 2.48-25.25). A HEART score of3 was 58% sensitive (95% CI: 32-81%) and 85% specific (95% CI: 83-87%) for MACE. The HEART score missed 5 cases of ACS among 1070 patients (0.5%) and could have reduced cardiac testing by 84.5% (904/1070). Combination of serial troponin0.065 ng/mL or HEART score3 resulted in sensitivity of 100% (95% CI: 72-100%), specificity of 83% (95% CI: 81-85%), and potential reduction in cardiac testing of 82% (879/1070).If used to guide stress testing and cardiac imaging, the HEART score could substantially reduce cardiac testing in a population with low pretest probability of ACS.

Published
2011

47. Impact of anticoagulation regimen prior to revascularization in patients with non‐ST‐segment elevation acute coronary syndromes: The ACUITY trial

Author

Geisler, Tobias, primary, Droppa, Michal, additional, Gawaz, Meinrad, additional, Steinhubl, Steven R., additional, Bertrand, Michel E., additional, Lincoff, A. Michael, additional, Cequier, Angel R., additional, Desmet, Walter, additional, Rasmussen, Lars H., additional, Hoekstra, James W., additional, Bernstein, Debra, additional, Deliargyris, Efthymios N., additional, Mehran, Roxana, additional, and Stone, Gregg W., additional

Published
2015
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48. The HEART Pathway Randomized Trial

Author

Mahler, Simon A., primary, Riley, Robert F., additional, Hiestand, Brian C., additional, Russell, Gregory B., additional, Hoekstra, James W., additional, Lefebvre, Cedric W., additional, Nicks, Bret A., additional, Cline, David M., additional, Askew, Kim L., additional, Elliott, Stephanie B., additional, Herrington, David M., additional, Burke, Gregory L., additional, and Miller, Chadwick D., additional

Published
2015
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49. Lessons in Flying

Author

Levy, Phillip D., primary, Dancy, JaNeen N., additional, Stowell, Stephanie A., additional, Hoekstra, James W., additional, Arthur, Crystal L., additional, Wilson, Charles H., additional, Bednar, John M., additional, Dorman, Todd, additional, and Hiestand, Brian, additional

Published
2014
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50. Stress CMR Reduces Revascularization, Hospital Readmission, and Recurrent Cardiac Testing in Intermediate-Risk Patients With Acute Chest Pain

Author

Miller, Chadwick D., primary, Case, L. Douglas, additional, Little, William C., additional, Mahler, Simon A., additional, Burke, Gregory L., additional, Harper, Erin N., additional, Lefebvre, Cedric, additional, Hiestand, Brian, additional, Hoekstra, James W., additional, Hamilton, Craig A., additional, and Hundley, W. Gregory, additional

Published
2013
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