Clinical event adjudication: Unstable angina requiring hospitalization

For the list of clinical event adjudication definitions, click here

Editors-in-Chief: C. Michael Gibson, M.S., M.D. [1]

WikiDoc Resources for Clinical event adjudication: Unstable angina requiring hospitalization
Articles
Most recent articles on Clinical event adjudication: Unstable angina requiring hospitalization Most cited articles on Clinical event adjudication: Unstable angina requiring hospitalization Review articles on Clinical event adjudication: Unstable angina requiring hospitalization Articles on Clinical event adjudication: Unstable angina requiring hospitalization in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Clinical event adjudication: Unstable angina requiring hospitalization Images of Clinical event adjudication: Unstable angina requiring hospitalization Photos of Clinical event adjudication: Unstable angina requiring hospitalization Podcasts & MP3s on Clinical event adjudication: Unstable angina requiring hospitalization Videos on Clinical event adjudication: Unstable angina requiring hospitalization
Evidence Based Medicine
Cochrane Collaboration on Clinical event adjudication: Unstable angina requiring hospitalization Bandolier on Clinical event adjudication: Unstable angina requiring hospitalization TRIP on Clinical event adjudication: Unstable angina requiring hospitalization
Clinical Trials
Ongoing Trials on Clinical event adjudication: Unstable angina requiring hospitalization at Clinical Trials.gov Trial results on Clinical event adjudication: Unstable angina requiring hospitalization Clinical Trials on Clinical event adjudication: Unstable angina requiring hospitalization at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Clinical event adjudication: Unstable angina requiring hospitalization NICE Guidance on Clinical event adjudication: Unstable angina requiring hospitalization NHS PRODIGY Guidance FDA on Clinical event adjudication: Unstable angina requiring hospitalization CDC on Clinical event adjudication: Unstable angina requiring hospitalization
Books
Books on Clinical event adjudication: Unstable angina requiring hospitalization
News
Clinical event adjudication: Unstable angina requiring hospitalization in the news Be alerted to news on Clinical event adjudication: Unstable angina requiring hospitalization News trends on Clinical event adjudication: Unstable angina requiring hospitalization
Commentary
Blogs on Clinical event adjudication: Unstable angina requiring hospitalization
Definitions
Definitions of Clinical event adjudication: Unstable angina requiring hospitalization
Patient Resources / Community
Patient resources on Clinical event adjudication: Unstable angina requiring hospitalization Discussion groups on Clinical event adjudication: Unstable angina requiring hospitalization Patient Handouts on Clinical event adjudication: Unstable angina requiring hospitalization Directions to Hospitals Treating Clinical event adjudication: Unstable angina requiring hospitalization Risk calculators and risk factors for Clinical event adjudication: Unstable angina requiring hospitalization
Healthcare Provider Resources
Symptoms of Clinical event adjudication: Unstable angina requiring hospitalization Causes & Risk Factors for Clinical event adjudication: Unstable angina requiring hospitalization Diagnostic studies for Clinical event adjudication: Unstable angina requiring hospitalization Treatment of Clinical event adjudication: Unstable angina requiring hospitalization
Continuing Medical Education (CME)
CME Programs on Clinical event adjudication: Unstable angina requiring hospitalization
International
Clinical event adjudication: Unstable angina requiring hospitalization en Espanol Clinical event adjudication: Unstable angina requiring hospitalization en Francais
Business
Clinical event adjudication: Unstable angina requiring hospitalization in the Marketplace Patents on Clinical event adjudication: Unstable angina requiring hospitalization
Experimental / Informatics
List of terms related to Clinical event adjudication: Unstable angina requiring hospitalization

This chapter presents unstable angina requiring hospitalization definitions used in the Clinical Event Committee adjudication processes. These definitions are current as of 3/26/10.

Unstable angina requiring hospitalization

Unstable angina requiring hospitalization is defined as:

1. Symptoms of myocardial ischemia at rest (chest pain or equivalent) or an accelerating pattern of angina with frequent episodes associated with progressively decreased exercise capacity
   AND
   
2. Prompting an unscheduled visit to a healthcare facility and hospitalization (including chest pain observation units) within 24 hours of the most recent symptoms
   AND
   
3. At least one of the following:

a. New or worsening ST or T wave changes on resting ECG

• ST elevation
  New ST elevation at the J point in two anatomically contiguous leads with the cut-off points: ≥ 0.2 mV in men (> 0.25 mV in men < 40 years) or ≥ 0.15 mV in women in leads V2-V3 and/or ≥ 0.1 mV in other leads.
• ST depression and T-wave changes
  New horizontal or down-sloping ST depression ≥ 0.05 mV in two contiguous leads; and/or new T inversion ≥ 0.1 mV in two contiguous leads.
  
  

The above ECG criteria illustrate patterns consistent with myocardial ischemia. It is recognized that lesser ECG abnormalities may represent an ischemic response and may be accepted under the category of abnormal ECG findings.

b. Definite evidence of myocardial ischemia on myocardial scintigraphy (clear reversible perfusion defect), stress echocardiography (reversible wall motion abnormality), or MRI (myocardial perfusion deficit under pharmacologic stress) that is believed to be responsible for the myocardial ischemic symptoms/signs

c. Angiographic evidence of ≥ 70% lesion and/or thrombus in an epicardial coronary artery that is believed to be responsible for the myocardial ischemic symptoms/signs

d. Need for coronary revascularization procedure (PCI or CABG) during the same hospital stay. This criterion would be fulfilled if the admission for myocardial ischemia led to transfer to another institution for the revascularization procedure without interceding home discharge

AND

4. No evidence of acute myocardial infarction

General Considerations

1. Escalation of pharmacotherapy for ischemia, such as intravenous nitrates or increasing dosages of β-blockers, should be considered supportive of the diagnosis of unstable angina. However, a typical presentation and admission to the hospital with escalation of pharmacotherapy, without any of the additional findings listed under category 3, would be insufficient alone to support classification as hospitalization for unstable angina.
   
2. If subjects are admitted with suspected unstable angina, and subsequent testing reveals a non-cardiac or non-ischemic etiology, this event should not be recorded as hospitalization for unstable angina. Potential ischemic events meeting the criteria for myocardial infarction should not be adjudicated as unstable angina.
   
3. Planned rehospitalization for performance of an elective revascularization in the absence of symptoms at rest prompting admission should not be considered a hospitalization for unstable angina. For example, a patient with stable exertional angina whose admission for coronary angiography and PCI is prompted by a positive outpatient stress test should not be considered a hospitalization for unstable angina.
   
4. A patient who undergoes an elective catheterization where incidental coronary artery disease is found and who subsequently undergoes coronary revascularization will not be considered as meeting the hospitalization for unstable angina endpoint.

References

1. ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine, Circulation, 2007, 116:803-877.
   
2. Campeau L, Grading of angina pectoris (letter), Circulation, 1976, 54:522-23.
   
3. Cutlip DE, S Windecker, R Mehran, A Boam, DJ Cohen, G-A van Es, PG Steg, M-A Morel, L Mauri, P Vranckx, E McFadden, A Lansky, M Hamon, MW Krucoff, PW Serruys and on behalf of the Academic Research Consortium, Clinical End Points in Coronary Stent Trials: A Case for Standardized Definitions, Circulation, 2007, 115:2344-2351.
   
4. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, Hatsukami TS, Higashida RT, Johnston SC, Kidwell CS, Lutsep HL, Miller E, Sacco RL; Definition and Evaluation of Transient Ischemic Attack, A Scientific Statement for Healthcare Professionals from the American Heart Association; American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease, Stroke, 2009 Jun; 40(6):2276-93. Epub 2009 May 7. Review.
   
5. Thygesen, Kristian, Alpert JS, White HD on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction. Universal Definition of Myocardial Infarction, Circulation, 2007, 116:1-20.