scholarly journals The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review

2021 ◽  
Vol 10 (2) ◽  
pp. 198
Author(s):  
Alban Belkouche ◽  
Hermann Yao ◽  
Alain Putot ◽  
Frédéric Chagué ◽  
Luc Rochette ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Artery Embolism ◽  
Myocardial Infraction ◽  
Coronary Artery Embolism ◽  
Coronary Syndromes ◽  
Embolic Risk ◽  
Af Recurrence

This review was conducted to emphasize the complex interplay between atrial fibrillation (AF) and myocardial infraction (MI). In type 1 (T1) MI, AF is frequent and associated with excess mortality. Moreover, AF after hospital discharge for T1MI is not rare, suggesting the need to improve AF screening and to develop therapeutic strategies for AF recurrence. Additionally, AF is a common trigger for type 2 MI (T2MI), and recent data have shown that tachyarrhythmia or bradyarrhythmia could be a causal factor in, respectively, 13–47% or 2–7% of T2MI. In addition, AF is involved in T2MI pathogenesis as a result of severe anemia related to anticoagulants. AF is also an underestimated and frequent cause of coronary artery embolism (CE), as a situation at risk of myocardial infarction with non-obstructive coronary arteries. AF-causing CE is difficult to diagnose and requires specific management. Moreover, patients with both AF and chronic coronary syndromes represent a therapeutic challenge because the treatment of AF include anticoagulation, depending on the embolic risk, and ischemic heart disease management paradoxically includes antiplatelet therapy.

scholarly journals EMBOLIC MYOCARDIAL INFARCTION. EXPERIENCE IN DIAGNOSIS AND MANAGEMENT

2018 ◽  
Vol 14 (3) ◽  
pp. 361-369 ◽  
Author(s):  
A. S. Shilova ◽  
E. M. Gilyarova ◽  
D. A. Andreev ◽  
D. Yu. Shchekochikhin ◽  
N. A. Novikova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Underlying Disease ◽  
Evidence Base ◽  
Diagnostic Features ◽  
Artery Embolism ◽  
Coronary Artery Embolism ◽  
Artery Disease ◽  
Essential Heterogeneity

Acute myocardial infarction (AMI) is one of the main causes of morbidity and mortality, both in the Russian Federation and around the world. Approximately, in up to 10% of patients with clinical diagnostic features of AMI, early angiography does not reveal an occluded vessel or possibly any evidence of coronary artery disease. These patients constitute an intriguing subgroup referred to as “Myocardial Infarction with Non-Obstructive Coronary Arteries” (MINOCA). MINOCA is a collective concept that unites many different pathologies, which determines the essential heterogeneity of the etiological factors. Coronary artery embolism is recognized as an important non-atherosclerotic cause of AMI. In turn, the most common underlying disease in those with coronary embolism is the atrial fibrillation. The advantages of reperfusion strategy and cardioprotective therapy in the treatment of obstructive arteriosclerosis are well studied, widely presented in the literature and supported by a strong evidence base, while the issues of diagnosis and treatment of patients with MINOCA are currently widely discussed We present two clinical cases of embolic myocardial infarction in patients with atrial fibrillation, diagnosed in our clinic in 2017.

scholarly journals Type 2 Myocardial Infarction: When Is It Really Type 1?

2016 ◽  
Vol 25 ◽  
pp. S70-S71
Author(s):  
J. Hung ◽  
J. Harrington ◽  
F. Scott ◽  
S. Verma
Keyword(s):  
Myocardial Infarction

Cardiac troponins and mortality in type 1 and 2 myocardial infarction

2017 ◽  
Vol 55 (2) ◽  
Author(s):  
Giuseppe Lippi ◽  
Fabian Sanchis-Gomar ◽  
Gianfranco Cervellin
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Troponin T ◽  
Post Discharge ◽  
Assay Sensitivity ◽  
Percentage Difference ◽  
Cardiac Troponins

AbstractBackground:The pathogenesis of different types of myocardial infarction (MI) differs widely, so that accurate and timely differential diagnosis is essential for tailoring treatments according to the underlying causal mechanisms. As the measurement of cardiac troponins is a mainstay for diagnosis and management of MI, we performed a systematic literature analysis of published works which concomitantly measured cardiac troponins in type 1 and 2 MI.Methods:The electronic search was conducted in Medline, Scopus and Web of Science using the keywords “myocardial infarction” AND “type(-)2” OR “type II” AND “troponin” in “Title/Abstract/Keywords”, with no language restriction and date limited from 2007 to the present.Results:Overall, 103 documents were identified, but 95 were excluded as precise comparison of troponin values in patients with type 1 and 2 MI was unavailable. Therefore, eight studies were finally selected for our analysis. Two studies used high-sensitivity (HS) immunoassays for measuring cardiac troponin T (HS-TnT), one used a HS immunoassay for measuring cardiac troponin I (HS-TnI), whereas the remaining used conventional methods for measuring TnI. In all studies, regardless of type and assay sensitivity, troponin values were higher in type 1 than in type 2 MI. The weighted percentage difference between type 1 and 2 MI was 32% for TnT and 91% for TnI, respectively. Post-discharge mortality obtained from pooling individual data was instead three times higher in type 2 than in type 1 MI.Conclusions:The results of our analysis suggest that the value of cardiac troponins is consistently higher in type 1 than in type 2 MI.

Abstract 13297: Short-Term Mortality in Patients With Myocardial Injury and Myocardial Infarction Type 1 and Type 2

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Laura Sarkisian ◽  
Lotte Saaby ◽  
Tina S Poulsen ◽  
Oke Gerke ◽  
Axel C Diederichsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Troponin I ◽  
Clinical Indication ◽  
Short Term ◽  
Cox Regression Analysis ◽  
Short Term Mortality

Introduction: Troponin elevations occur in a myriad of clinical conditions other than myocardial infarction (MI) and imply a poor prognosis. So far, data comparing the short-term outcome in patients with myocardial injury vs. patients with type 1 or type 2 MI are not available. Methods: Over a 1-year period we prospectively studied hospitalized patients having cardiac troponin I (cTnI) measured on clinical indication. The diagnosis of type 1 and type 2 MI was according to the universal definition involving a rising and/or falling pattern of cTnI values above the decision limit of 30 ng/L. cTnI elevations above this limit in patients without overt myocardial ischemia were defined as myocardial injury. A 1-month follow-up was done with mortality as endpoint. Results: The study covered 1577 consecutive patients with cTnI values >30 ng/L, of whom 360 had a type 1 MI, 119 a type 2 MI and 1089 had myocardial injury. Type 1 MI patients were younger with a median age of 70 (IQR 61-81) yrs, whereas the median ages in type 2 MI and myocardial injury were higher but comparable : 78 (IQR 67-84) vs. 77 (IQR 67-85) yrs. Peak cTnI values, however, were highest in type 1 MI: 3820 (530-19030) ng/L, lower in type 2 MI: 850 (390-3270) ng/L, and smallest in patients with myocardial injury: 90 (50-270) ng/L (p=0.0001). At one-month follow-up 285 patients had died. Mortality in the different subgroups was: 9% (33/360) in type 1 MI, 24% (28/119) in type 2 MI, and 21% (224/1089) in patients with myocardial injury. The results are depicted in the figure (Kaplan-Meier curves, log-rank-test; p-value <0.0001). Multivariate COX regression analysis revealed a Hazard Ratio (95%) of 2.1 (1.2-3.7) for type 2 MI and 1.4 (0.9-2.1) for myocardial injury. Conclusion: The short-term mortality in patients with myocardial injury and type 2 MI is almost identical but higher than in patients with type 1 MI. These prognostic findings imply that the clinical distinction between myocardial injury and type 2 MI may be somewhat artificial.

Fractional flow reserve in patients with type 1 or type 2 non-ST elevation acute myocardial infarction

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Marco Arena ◽  
Giorgio Caretta ◽  
Roberto Gistri ◽  
Giorgio Tonelli ◽  
Veronica Scardigli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
St Elevation ◽  
Elevation Acute Myocardial Infarction
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