Mechanisms precipitating acute cardiac events: review and recommendations of an NHLBI workshop. National Heart, Lung, and Blood Institute. Mechanisms Precipitating Acute Cardiac Events Participants.

Abstract

The National Heart, Lung, and Blood Institute held a workshop on August 28–29, 1995, to survey what is known about mechanisms precipitating acute cardiac events and to assess the potential that advances in this field can lead to new methods of prevention of acute cardiovascular disease. Based on data presented at the workshop and subsequent discussions, this document summarizes some of the factors involved in the onset of cardiac events and describes research opportunities in this rapidly developing, multidisciplinary field. This field can best be appreciated by viewing its relationship to the traditional fields of research on coronary artery disease, as shown in Fig 1⇓. This figure illustrates some of the factors involved at each of several stages of disease, from the cumulative effects of risk factors to long-term management and rehabilitation. Extensive research has been conducted on long-term risk exposure, short-term treatment, and long-term preventive therapy. The study of precipitating or triggering mechanisms—the events occurring in the hours and minutes before the cardiovascular event—has been limited by the fact that they occur primarily out of hospital and over a brief time period in individuals who cannot be identified prospectively among those at high risk for a coronary heart disease (CHD) event. Figure 1. Position of relatively undeveloped area of research on conversion of chronic to acute disease with respect to traditional areas of research on coronary artery disease. ASA indicates aspirin; AF, autonomic function; CABG, coronary artery bypass graft; EP, electrophysiological; ETT, exercise treadmill testing; MI, myocardial infarction; PTCA, percutaneous transluminal coronary angioplasty; and SCD, sudden cardiac death. Adapted from Reference 23. Figure 2. Interactions between chronic and acute risk factors influence pathophysiological processes to modulate the likelihood that a patient with CHD will experience an acute event. Therapeutic influences act at several levels to modify the underlying risk. AAD indicates …