scholarly journals Update on the Universal Definition of Acute Myocardial Infarction in the Light of New Data

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
K. Thygesen ◽  
J. Searle
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Ischemia ◽  
European Heart Journal ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
Number Of Patients ◽  
Percutaneous Coronary ◽  
Universal Definition ◽  
Definition Of ◽  
European Society Of Cardiology

At the 2012 European Society of Cardiology (ESC) Conference in Munich, the updated Universal Definition of myocardial infarction was presented for the first time and was then published simultaneously in five medical journals (European Heart Journal, Circulation, Journal of American College of Cardiology, Nature Reviews Cardiology, Global Heart). Major changes in this updated version include the differentiation between myocardial ischemia and myocardial injury, which gives credit to the relatively large number of patients with troponin positive test results, especially when measured with high sensitivity assays, in patients without myocardial ischemia. Another important topic is the revised criteria for the diagnoses of acute myocardial ischemia related to percutaneous coronary intervention (PCI) and coronary arterial bypass grafting (CABG).

scholarly journals The importance of modern high - sensitivity troponin tests in the diagnosis of myocardial infarction without ST-segment elevation

2019 ◽  
Vol 91 (9) ◽  
pp. 137-144
Author(s):  
O V Abaturova ◽  
S N Suplotov ◽  
L V Kremneva ◽  
S V Shalaev
Keyword(s):  
Myocardial Infarction ◽  
Literature Review ◽  
High Sensitivity ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Sensitivity Tests ◽  
Universal Definition ◽  
Definition Of ◽  
European Society Of Cardiology

The literature review presents the characteristics of modern high - sensitivity tests for detection of Tn (hs - cTn) in the blood and the results of large studies on the diagnosis of non segment elevation myocardial infarction (nonSTEMI) using hs - cTn. The results of these studies served as the basis for the development of three - and one - hour diagnostic algorithms nonSTEMI, presented in the recommendations of the European Society of Cardiology 2012 and 2015 and also in fourth Universal Definition of Myocardial Infarction 2018.

scholarly journals Consensus or Controversy?: Evolution of Criteria for Myocardial Infarction After Percutaneous Coronary Intervention

2017 ◽  
Vol 63 (1) ◽  
pp. 82-90 ◽  
Author(s):  
Pierluigi Tricoci
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Randomized Clinical Trials ◽  
Prognostic Significance ◽  
Coronary Intervention ◽  
Diagnostic Tools ◽  
The Third ◽  
Percutaneous Coronary ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND The definition and the clinical implications of myocardial infarction (MI) occurring in the setting of percutaneous coronary intervention have been subjects of unresolved controversy. As a result of the use of more sensitive diagnostic tools such as cardiac troponin, the expanding evidence, and the ensuing debate, the definition of procedural MI (pMI) has evolved, leading to several revisions, different proposed definitions, and lack of standardization in randomized clinical trials. CONTENT In this review, we will describe the key clinical data on cardiac biomarkers, creatine kinase isoenzyme MB and cTn, in the setting of percutaneous coronary intervention and the main issues that have lead to various consensus documents with a proposed definition of pMI. We will focus on the rationale of the current “Third Universal Definition of Myocardial Infarction” and of the alternative approach proposed by the Society for Cardiovascular Angiography and Interventions. SUMMARY The definition of pMI is an evolving field where the Third Universal MI definition represents the best attempt to date to incorporate available evidence along with scientific and clinical judgment into criteria to ensure adequate specificity in the diagnosis and the relevant prognostic significance, while trying to maintain sensitivity. Questions on the recommended criteria and their practical implementation remain, but the Third Universal definition document represents an important milestone toward a better standardization and enhanced consensus on the pMI definition.

Abstract P254: Dementia and Use of Cardiac Catheterization and Angioplasty in Elderly ST-Elevation Myocardial Infarction Patients

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Marianne Ketterl ◽  
James A Mortimer ◽  
Elizabeth B Pathak
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Catheterization ◽  
Coronary Intervention ◽  
Admission Diagnosis ◽  
Percutaneous Coronary ◽  
Treatment Disparities ◽  
St Elevation ◽  
The Mean ◽  
Definition Of ◽  
To Receive

Introduction_ Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). Few studies addressed dementia as a barrier to receiving PCI. We evaluated disparities in the use of cardiac catheterization and PCI in STEMI patients with dementia. Methods_ A retrospective analysis was performed of Florida's comprehensive inpatient surveillance system for the years 2006-2007 with admission diagnosis of STEMI (ICD-9-CM codes 410.0 - 410.6, 410.8). Data were limited to patients ≥65 years admitted to hospitals with a high annual volume of PCIs (≥400), and transfer patients were excluded. We used a broad definition of dementia (ICD-9-CM codes 294.0, 294.1, 294.8, 294.9, 331.0-331.2, 331.7, 331.81, 331.82, 331.89, 331.9, 780.93, 780.97, 797). Logistic regression analysis was used to identify disparities in the use of cardiac catheterization and PCI among all STEMI patients, and in the use of PCI only among STEMI patients who received cardiac catheterization. Results_ A total of 8,310 STEMI patients who met our inclusion criteria were identified. Of these, 77.2% were catheterized and 67.1% received PCI. The mean age of the cohort was 76.3 years (SD 7.8 yrs); with 43.3% female; 83.4% white, 4.6% black, and 12% Hispanic/other. A total of 605 (7.3%) were demented. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.4, 95% CI 0.3-0.5), and less likely to receive PCI (RR 0.4, 95% CI 0.4-0.5) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI for demented vs. non-demented patients (p=0.32).Women were less likely to be catheterized than males (RR 0.7, 95% CI 0.7-0.8), but if catheterized, were more likely to receive PCI then men (RR 1.3, 95% CI 1.1-1.6). After adjustment for age, gender, and dementia, blacks were less likely to be catheterized (RR 0.5, 95% CI 0.4-0.6) and less likely to receive PCI (RR 0.6, 95% CI 0.5-0.7) than whites. Conclusions_ STEMI patients with dementia were much less likely to receive cardiac catheterization and consequently PCI. Our study confirms that treatment disparities exist for elderly demented patients after controlling for age, gender and ethnicity.

Abstract 19710: Causes for Increased Cardiac Troponin I Using Gender-Specific 99th Percentiles From a High Sensitivity Assay in a US Population

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Yader Sandoval ◽  
Stephen W Smith ◽  
Karen M Schulz ◽  
MaryAnn M Murakami ◽  
Fred S Apple
Keyword(s):  
Myocardial Ischemia ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Plaque Rupture ◽  
High Sensitivity ◽  
The United States ◽  
Universal Definition ◽  
Definition Of ◽  
Gender Specific

Introduction: High-sensitivity cardiac troponin (hs-cTn) assays have not yet been FDA cleared for clinical use in the United States (US). Pending expected approval of hs-cTn assays, which will use gender-specific cutoffs (GSC), it is relevant to recognize the causes of cTn increases using hs-cTnI assays in a US population. Our purpose was to describe the frequency of distinct etiologies of hs-cTnI assay increases using GSC. Methods: Retrospective study of 310 patients with serial hs-cTnI (Abbott ARCHITECT, 99th percentiles: F:16 ng/L; M:34 ng/L) measurements. Patients with an increased hs-cTnI were adjudicated into categories according to the 3rd Universal Definition of MI. Categories included, A: primary myocardial ischemia (i.e. plaque rupture); B: injury secondary to supply/demand imbalance; C: injury not related to myocardial ischemia (i.e. cardiac contusion, ablation, shock, surgery); D: multifactorial or indeterminate myocardial injury (i.e. heart failure, critically ill, pulmonary HTN, sepsis, stroke, renal failure, pulmonary embolism); E: Unknown. Results: 127 (41%) had an increased hs-cTnI above the GSC 99th percentile, whereas 183 (59%) had a normal hs-cTnI. The most common causes of hs-cTnI increases were: a) multifactorial or indeterminate injury - 43% among all patients and 52% in males, and b) supply/demand imbalance - 39% in women (Table). Injury related to primary myocardial ischemia was present in 10% (n=13). Females had more injury related to supply/demand ischemia than males (39% vs. 18%, p=0.01), whereas males had more multifactorial or indeterminate injury (52% vs. 33%, p=0.05). Conclusions: Most increased hs-cTnI values were explained by non-plaque rupture conditions. Males tended to have hs-cTnI increases due to multifactorial/indeterminate causes, whereas in women supply/demand imbalance was the most common etiology. Investigations are needed to better understand if etiologies of myocardial injury have gender differences.

Primary percutaneous coronary intervention for ST-elevation myocardial infarction

2018 ◽  
pp. 251-272
Author(s):  
Zulfiquar Adam ◽  
Mark A. de Belder
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Optimal Timing ◽  
Percutaneous Coronary ◽  
Short And Long Term ◽  
St Elevation ◽  
European Society Of Cardiology

This chapter covers primary percutaneous coronary intervention (PPCI), with an investigation of the limitations of the competing thrombolysis procedure, optimal timing, and a discussion of the technical aspects associated with delivering PPCI. Comparing randomized trials that look at differential outcomes in both the short and long term, and covering the European Society of Cardiology guidelines for ST-elevation myocardial infarction treatment, the chapter provides an overview and analysis of the risks and benefits of PPCI.

scholarly journals Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction

2019 ◽  
Vol 65 (3) ◽  
pp. 484-489 ◽  
Author(s):  
Atul Anand ◽  
Anoop S V Shah ◽  
Agim Beshiri ◽  
Allan S Jaffe ◽  
Nicholas L Mills
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Clinical Pathways ◽  
High Sensitivity ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
Diagnostic Threshold ◽  
Serial Sampling ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND The universal definition of myocardial infarction (UDMI) standardizes the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing is recommended because these assays have improved precision at low concentrations, but concerns over specificity may have limited their implementation. METHODS We undertook a global survey of 1902 medical centers in 23 countries evenly distributed across 5 continents to assess adoption of key recommendations from the UDMI. Respondents involved in the diagnosis and management of patients with suspected acute coronary syndrome completed a structured telephone questionnaire detailing the primary biomarker, diagnostic thresholds, and clinical pathways used to identify myocardial infarction. RESULTS Cardiac troponin was the primary diagnostic biomarker at 96% of surveyed sites. Only 41% of centers had adopted high-sensitivity assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity troponin more frequently used serial sampling pathways (91% vs 78%) and the 99th percentile diagnostic threshold (74% vs 66%) than sites using previous-generation assays. Furthermore, high-sensitivity institutions more often used earlier serial sampling (≤3 h) and accelerated diagnostic pathways. Fewer than 1 in 5 high-sensitivity sites had adopted sex-specific thresholds (18%). CONCLUSIONS There has been global progress toward the recommendations of the UDMI, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are still used by a minority of sites, and sex-specific thresholds by even fewer. Additional efforts are required to improve risk stratification and diagnosis of patients with myocardial infarction.

scholarly journals Association of Pre-procedural High Sensitivity C-Reactive Protein with In-hospital Outcome of Patients Undergoing Percutaneous Coronary Intervention

2017 ◽  
Vol 42 (1) ◽  
pp. 01-07
Author(s):  
Sufia Jannat ◽  
MD Abdul Kader Akanda ◽  
Md Khalequzzaman ◽  
Mohammad Ullah ◽  
Md Monirujjaman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
High Sensitivity ◽  
Coronary Intervention ◽  
C Reactive Protein ◽  
Hospital Outcome ◽  
Reactive Protein ◽  
Inflammatory Status ◽  
Group I ◽  
Percutaneous Coronary

Emerging evidence links an elevated baseline inflammatory status to adverse outcome among patients undergoing percutaneous coronary intervention (PCI). Baseline inflammation measured by high sensitivity C-reactive protein hsCRP may prove useful for identification of high risk patients requiring adjunctive therapies. This prospective study was carried out in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, during October 2012 to September 2013.Two hundred consecutive patients with CSA and UA undergoing PCI were included in the study. Study patients were divided into two groups on the basis of hsCRP levels. In Group I hsCRP levels were elevated, that is ?3 mg/L and in Group II hsCRP levels were normal, that is < 3 mg/L, with 100 patients in each group. Fol-lowing the procedure in-hospital outcome of study patients were observed. Increased inci-dence (44%) of adverse in-hospital outcome was found in Group I (44% Vs. 11%). Higher incidence of post procedural angina (17%), peri-procedural myocardial infarction (6%) and peri-procedural myocardial injury (10%) was observed in this group. Nonsignificant rate of acute myocardial infarction, significant arrhythmia, acute LVF, cardiogenic shock and death were found in elevated hsCRP Group. Overall Major Adverse Cardiac Events (6% Vs. 0%) were found in pre-procedural elevated hsCRP group. High sensitivity C-reactive protein remained independently predictive of adverse in-hospital outcome, with 95% CI of RR 1.4 – 4.4 and p<001. The present study concludes that the hsCRP is an important and independent predictor of adverse in hospital outcome.

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