Acute Myocardial Infarction Anderson, Jeffrey L; Morrow, David A
The New England journal of medicine,
05/2017, Letnik:
376, Številka:
21
Journal Article
Authors/Task Force Members/Chairpersons Kristian Thygesen∗ (Denmark) Joseph S. Alpert∗ (USA) Allan S. Jaffe (USA) Bernard R. Chaitman (USA) Jeroen J. Bax (the Netherlands) David A. Morrow (USA) ...Harvey D. White∗ (New Zealand) Hans Mickley (Denmark) Filippo Crea (Italy) Frans Van de Werf (Belgium) Chiara Bucciarelli-Ducci (UK) Hugo A. Katus (Germany) Fausto J. Pinto (Portugal) Elliott M. Antman (USA) Christian W. Hamm (Germany) Raffaele De Caterina (Italy) James L. Januzzi Jr (USA) Fred S. Apple (USA) Maria Angeles Alonso Garcia (Spain) S. Richard Underwood (UK) John M. Canty Jr (USA) Alexander R. Lyon (UK) P.J. Devereaux (Canada) Jose Luis Zamorano (Spain) Bertil Lindahl (Sweden) William S. Weintraub (USA) L. Kristin Newby (USA) Renu Virmani (USA) Pascal Vranckx (Belgium) Don Cutlip (USA) Raymond J. Gibbons (USA) Sidney C. Smith (USA) Dan Atar (Norway) Russell V. Luepker (USA) Rose Marie Robertson (USA) Robert O. Bonow (USA) P. Gabriel Steg (France) Patrick T. O'Gara (USA) Keith A. A. Fox (UK)Document Reviewers David Hasdai (CPG Review Coordinator) (Israel) Victor Aboyans (France) Stephan Achenbach (Germany) Stefan Agewall (Norway) Thomas Alexander (India) Alvaro Avezum (Brazil) Emanuele Barbato (Italy) Jean-Pierre Bassand (France) Eric Bates (USA) John A. Bittl (USA) Güenter Breithardt (Germany) Héctor Bueno (Spain) Raffaele Bugiardini (Italy) Mauricio G. Cohen (USA) George Dangas (USA) James A. de Lemos (USA) Victoria Delgado (the Netherlands) Gerasimos Filippatos (Greece) Edward Fry (USA) Christopher B. Granger (USA) Sigrun Halvorsen (Norway) Mark A. Hlatky (USA) Borja Ibanez (Spain) Stefan James (Sweden) Adnan Kastrati (Germany) Christophe Leclercq (France) Kenneth W. Mahaffey (USA) Laxmi Mehta (USA) Christian Müller (Switzerland) Carlo Patrono (Italy) Massimo Francesco Piepoli (Italy) Daniel Piñeiro (Argentina) Marco Roffi (Switzerland) Andrea Rubboli (Italy) Marc Ruel (Canada) Samin Sharma (USA) Iain A. Simpson (UK) Michael Tendera (Poland) Marco Valgimigli (Switzerland) Allard C. van der Wal (the Netherlands) Stephan Windecker (Switzerland)Table of Contents Abbreviations and acronyms2234 What is new in the Universal Definition of Myocardial Infarction? 2234 Universal definitions of myocardial injury and myocardial infarction: summary2235 Introduction2235 Pathological characteristics of myocardial ischaemia and infarction2236 Biomarker detection of myocardial injury and infarction2236 Clinical presentations of myocardial infarction2238 Clinical classification of myocardial infarction2238 7.1.Myocardial infarction type 12238 7.2.Myocardial infarction type 22239 7.3.Myocardial infarction type 2 and myocardial injury2241 7.4.Myocardial Infarction type 32242 8. References2260 Abbreviations and Acronyms ACS Acute coronary syndrome AHA American Heart Association ARC-2 Academic Research Consortium-2 AUC Area under the curve CAD Coronary artery disease CABG Coronary artery bypass grafting CKD Chronic kidney disease CK-MB Creatine kinase MB isoform CMR Cardiac magnetic resonance CTCA Computed tomographic coronary angiography cTn Cardiac troponin cTnI Cardiac troponin I cTnT Cardiac troponin T CT Computed tomography CV Coefficient of variation EF Ejection fraction ECG Electrocardiogram or electrocardiographic HF Heart failure hs-cTn High-sensitivity cardiac troponin IFCC International Federation of Clinical Chemistry and Laboratory Medicine ISFC International Society and Federation of Cardiology LAD Left anterior descending artery LBBB Left bundle branch block; LoD Limit of detection LGE Late gadolinium enhancement LGE-CMR Late gadolinium enhancement cardiac magnetic resonance LV Left ventricular LVH Left ventricular hypertrophy MI Myocardial infarction MINOCA Myocardial infarction with non-obstructive coronary arteries MONICA MONItoring of trends and determinants in CArdiovascular disease MPS Myocardial perfusion scintigraphy NHLBI National Heart, Lung, and Blood Institute NSTEMI Non-ST-elevation myocardial infarction PET Positron emission tomography PCI Percutaneous coronary intervention POC Point of care RBBB Right bundle branch block SPECT Single photon emission computed tomography STEMI ST-elevation myocardial infarction ST-T ST-segment–T wave TIMI Thrombolysis In Myocardial Infarction TTS Takotsubo syndrome UDMI Universal Definition of Myocardial Infarction URL Upper reference limit WHF World Heart Federation WHO World Health Organization 1 What is New in the Universal Definition of Myocardial Infarction? Silent or unrecognized myocardial infarction.ECG = electrocardiogram; MINOCA = myocardial infarction with non-obstructive coronary arteries; STEMI = ST-elevation myocardial infarction. 2 Universal Definitions of Myocardial Injury and Myocardial Infarction: Summary Universal definitions of myocardial injury and myocardial infarctionCriteria for myocardial injuryThe term myocardial injury should be used when there is evidence of elevated cardiac troponin values (cTn) with at least one value above the 99th percentile upper reference limit (URL).
This clinical practice guideline for the evaluation and diagnosis of chest pain provides recommendations and algorithms for clinicians to assess and diagnose chest pain in adult patients.
A ...comprehensive literature search was conducted from November 11, 2017, to May 1, 2020, encompassing randomized and nonrandomized trials, observational studies, registries, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, Agency for Healthcare Research and Quality reports, and other relevant databases. Additional relevant studies, published through April 2021, were also considered. Structure: Chest pain is a frequent cause for emergency department visits in the United States. The "2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain" provides recommendations based on contemporary evidence on the assessment and evaluation of chest pain. This guideline presents an evidence-based approach to risk stratification and the diagnostic workup for the evaluation of chest pain. Cost-value considerations in diagnostic testing have been incorporated, and shared decision-making with patients is recommended.
Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States annually. Whether the initiation of sacubitril-valsartan therapy is safe and effective among ...patients who are hospitalized for acute decompensated heart failure is unknown.
We enrolled patients with heart failure with reduced ejection fraction who were hospitalized for acute decompensated heart failure at 129 sites in the United States. After hemodynamic stabilization, patients were randomly assigned to receive sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily) or enalapril (target dose, 10 mg twice daily). The primary efficacy outcome was the time-averaged proportional change in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration from baseline through weeks 4 and 8. Key safety outcomes were the rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema.
Of the 881 patients who underwent randomization, 440 were assigned to receive sacubitril-valsartan and 441 to receive enalapril. The time-averaged reduction in the NT-proBNP concentration was significantly greater in the sacubitril-valsartan group than in the enalapril group; the ratio of the geometric mean of values obtained at weeks 4 and 8 to the baseline value was 0.53 in the sacubitril-valsartan group as compared with 0.75 in the enalapril group (percent change, -46.7% vs. -25.3%; ratio of change with sacubitril-valsartan vs. enalapril, 0.71; 95% confidence interval CI, 0.63 to 0.81; P<0.001). The greater reduction in the NT-proBNP concentration with sacubitril-valsartan than with enalapril was evident as early as week 1 (ratio of change, 0.76; 95% CI, 0.69 to 0.85). The rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema did not differ significantly between the two groups.
Among patients with heart failure with reduced ejection fraction who were hospitalized for acute decompensated heart failure, the initiation of sacubitril-valsartan therapy led to a greater reduction in the NT-proBNP concentration than enalapril therapy. Rates of worsening renal function, hyperkalemia, symptomatic hypotension, and angioedema did not differ significantly between the two groups. (Funded by Novartis; PIONEER-HF ClinicalTrials.gov number, NCT02554890 .).
Abstract Background Ezetimibe improves cardiovascular (CV) outcomes in patients stabilized after acute coronary syndrome (ACS) when added to statin therapy. After ACS, patients vary considerably in ...their risk for recurrent CV events. Objectives This study tested the hypothesis that atherothrombotic risk stratification may be useful to identify post-ACS patients who have the greatest potential for benefit from the addition of ezetimibe to statin therapy. Methods The TIMI (Thrombolysis In Myocardial Infarction) Risk Score for Secondary Prevention (TRS 2°P) is a simple 9-point risk stratification tool, previously developed in a large population with atherothrombosis to predict CV death, myocardial infarction (MI), and ischemic stroke (CV death/MI/ischemic cerebrovascular accident iCVA). The current study applied this tool prospectively to 17,717 post-ACS patients randomized either to ezetimibe and simvastatin or to placebo and simvastatin in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial). Treatment efficacy was assessed by baseline risk for CV death/MI/iCVA, the IMPROVE-IT composite endpoints (CE), and individual component endpoints at 7 years. Results All 9 clinical variables in the TRS 2°P were independent risk indicators for CV death/MI/iCVA (p < 0.001). The integer-based scheme showed a strong graded relationship with the rate of CV death/MI/iCVA, the trial CE, and the individual components (p trend <0.0001 for each). High-risk patients (n = 4,393; 25%), defined by ≥3 risk indicators, had a 6.3% (95% confidence interval: 2.9% to 9.7%) absolute risk reduction in CV death/MI/iCVA at 7 years with ezetimibe/simvastatin, thus translating to a number-needed-to-treat of 16. Intermediate-risk patients (2 risk indicators; n = 5,292; 30%) had a 2.2% (95% confidence interval: −0.3% to 4.6%) absolute risk reduction. Low-risk patients (0 to 1 risk indicators; n = 8,032; 45%) did not appear to derive benefit from the addition of ezetimibe (p interaction = 0.010). Similar findings were observed for the IMPROVE-IT primary CE. Conclusions Atherothrombotic risk stratification using the TRS 2°P identifies high-risk patients who derive greatest benefit from the addition of ezetimibe to statin therapy for secondary prevention after ACS. (Improved Reduction of Outcomes: Vytorin Efficacy International Trial IMPROVE-IT; NCT00202878 )
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