Criteria For Acute Myocardial Infarction Research Articles

Troponin efficacy in the diagnosis of acute coronary syndrome in patients with chronic renal failure.

There is no consensus on whether cardiac troponins with high reliability values should be different diagnostic criteria for acute myocardial infarction in patients with and without renal dysfunction. Although it is often emphasized that the etiology of elevated troponin levels in chronic kidney disease (CKD) remains unclear, elevated cardiac troponin (cTnT) levels have been associated with increased subclinical cardiac damage in these patient groups. In this study, we investigated the value of cTnT value in diagnosing acute coronary syndrome in CKD patients with high clinical suspicion of acute coronary syndrome and without acute ST segment elevation on electrocardiogram. The aim was to prevent cardiac ischemia from being overlooked in CKD patients. Coronary angiography revealed vessel occlusion in 192 patients, and the mortality rate after treatment decisions was 6.7%. The first measured troponin results showed a significant difference in patients who did not survive, indicating the prognostic value of troponin levels. Troponin values were compared with cardiovascular pathologies obtained by angiography, and elevated troponin levels strongly correlated with pathologic angiography results. The conclusion highlighted that despite prognostic uncertainties, biomarkers used for acute myocardial infarction diagnosis in patients with renal insufficiency are reliable in those with renal dysfunction. Elevated cTnT levels in CKD patients are considered a clear marker of cardiac ischemia, emphasizing the need for careful consideration of troponin values in this population.

Myocardial ischemia – reperfusion injury

Aim. To summarize and broaden the idea about mechanisms of acute coronary insufficiency development and pathophysiological features of myocardial reperfusion injury. Today, in the event of acute coronary syndrome, according to the latest recommendations for myocardial revascularization, percutaneous coronary intervention should be performed to determine the anatomy of coronary artery lesions and further percutaneous therapy. But in some patients, after blood flow restoration, reperfusion injury occurs, which is primarily related to the duration of ischemia, infarct size, and the myocardial resistance to ischemia. Treatment of myocardial infarction, like any treatment method, has evolved. In the 60s of the previous century, it included morphine, oxygen, warfarin and bed rest for 4–6 weeks. Then, during the 70s, it consisted of morphine, oxygen, lidocaine, warfarin, bed rest for 2–3 weeks and possibly coronary angiography for the further bypass surgery. The late 1970s saw the rapid progress in thrombolysis, first intravenous and then intracoronary. And starting in the early 1980s, since G. Hartzler performed the first balloon angioplasty for acute coronary artery occlusion, the stage of mechanical myocardial reperfusion has come. At the same time, knowledge about the pathophysiology of acute coronary ischemia was deepened. The World Health Organization developed ECG criteria for acute myocardial infarction using population-based studies in the 1950s–1970s, and additional four normative European regulations since then were issued defining concepts, key points of diagnosis and possible complications of myocardial infarction. Conclusions. The development of myocardial ischemic-reperfusion injury is a staged process that has a complex pathogenesis, its own clinical manifestations, and an association with more negative long-term outcomes of myocardial infarction treatment. Its main components are myocardial swelling involving cardiomyocytes, endotheliocytes, and the interstitial space; downregulation of cytoskeleton and disruption of sarcolemma integrity; increased vascular wall permeability; spasm of arterioles; intravascular accumulation of platelets and leukocytes, and the resultant the most severe form of myocardial damage is intramyocardial hemorrhage. Clinically, this is manifested by the no-reflow phenomenon following percutaneous coronary intervention.

Judging the clinical suitability of analytical performance of cardiac troponin assays.

New millennium diagnostic criteria for acute myocardial infarction precipitated a revolutionary shift from an approach based primarily on electrocardiography and clinical symptoms to a strategy based on biomarkers, and preferably cardiac troponins (cTn) I and T.In the last 20 years, clinical recommendations have strengthened the role of cTn and led to the development ofhighly sensitive (hs-cTn) assays, which are now leadingplayers in all current clinical practice guidelines. To optimize the clinical use of these hs-cTn assays, focus on their analytical aspects has become increasingly important, emphasizing the need for the establishment of suitable analytical performance by the definition andimplementation of appropriate specifications. An accurate estimate of measurement uncertainty, together with the acquisition of the highest analytical quality whenverylow concentrations of hs-cTn are measured, are essential requirements and should represent a practical laboratory standard in assuring optimal clinical use.Additional goals for further improving the quality of laboratory information should be the establishment of robust data concerning biological variation of cTn and theresolution of practical challenges opposed to the harmonization of cTn I results obtained by differing commercial measuring systems.

A case of acute myocardial infarction in paced rhythm. Utility of the Barcelona algorithm

We describe the case of a 70-year-old man with a pacemaker implant who presented to us with atypical chest pain. His admission ECG did not satisfy the criteria for myocardial infarction according to standard Sgarbossa criteria, and Smith modified Sgarbossa criteria. However, we applied the recently developed Barcelona algorithm, which is used to diagnose acute myocardial infarction in the presence of intrinsic left bundle branch block.Electrocardiographic criteria for an acute myocardial infarction were met. Lead V6 displayed a low voltage QRS complex (3 mm) with 1 mm ST depression, satisfying the Barcelona criteria for acute myocardial infarction. He underwent primary angioplasty for critical in-stent restenosis of the left anterior descending coronary artery. This is the first case report, to the best of our knowledge, where Barcelona algorithm has been used to diagnose acute coronary syndrome in right-ventricular paced rhythm.

Myocardial bridging is significantly associated with myocardial infarction with non-obstructive coronary arteries

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial infarction in the absence of obstructive coronary artery disease on angiography. We aim to investigate the relationship between myocardial bridging (MB) and MINOCA. Methods An observational retrospective study was conducted on 15,036 patients who had been referred for coronary angiography and who fulfilled the Fourth Universal Definition of Myocardial Infarction. The study population was divided into STEMI and non-STEMI patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. Statistical analyses were carried out by using SPSS, version 20. Results The prevalence of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%). MINOCA accounted for 14.5% of spontaneous myocardial infarction, and the clinical presentation was frequently NSTEMI rather than STEMI (84.3% vs. 15.7%). After adjusting for confounders, multivariate analyses showed a positive association between MB and MINOCA [OR=3.28, 95% CI (2.34; 4.61) p<0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female. Conclusion MB is a risk factor for MINOCA. Because MB prevalence differed significantly between the controls (CAD group) and cases (MINOCA group), which were positively associated to MB, it seems likely that MB would be a potential cause of MINOCA. Investigations for MB in MINOCA cases and especially in NSTEMI patients seem necessary. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Rangueil Hospital

Myocardial bridging is significantly associated to myocardial infarction with non-obstructive coronary arteries.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a common disorder characterized by the presence of clinical criteria for acute myocardial infarction in the absence of obstructive coronary artery disease on angiography. We aim to investigate the relationship between myocardial bridging (MB) and MINOCA. An observational retrospective study was conducted on 15 036 patients who had been referred for coronary angiography and who fulfilled the Fourth Universal Definition of Myocardial Infarction. The study population was divided into ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients, from which we defined two main groups: the MINOCA group and the coronary artery disease (CAD) group. Statistical analyses were carried out by using SPSS, version 20. The prevalence of angiographic MB among the groups was significantly greater in the MINOCA group (2.9% vs. 0.8%). MINOCA accounted for 14.5% of spontaneous myocardial infarction, and the clinical presentation was more frequently NSTEMI rather than STEMI (84.3% vs. 15.7%). After adjusting for confounders, multivariate analyses showed a positive association between MB and MINOCA [odds ratio = 3.28, 95% CI (2.34; 4.61) P < 0.001]. Cardiovascular risk factors were less common in the MINOCA population, which was younger and more often female. MB is a risk factor for MINOCA. Because MB prevalence differed significantly between the controls (CAD group) and cases (MINOCA group), which were positively associated to MB, it seems likely that MB would be a potential cause of MINOCA. Investigations for MB in MINOCA cases and especially in NSTEMI patients seem necessary.

In-Hospital Outcome of Acute Myocardial Infarction in patients receiving Streptokinase

Objective: To study and compare the in-hospital mortality due to acute myocardial infarction in patients receiving thrombolytic (streptokinase) therapy versus those who were not thrombolysed. Methods: This descriptive observational study was conducted at the Coronary care Unit and Cardiology ward of Nishtar Hospital, Multan, from 1St of October 2002 till 30th of April 2003. Four hundred and thirty four patients of acute myocardial infarction who fulfilled WHO criteria of acute myocardial infarction were included in the study. Patients were divided into two groups: patients receiving streptokinase (SK) group and patients not receiving streptokinase (Non-SK) group. In-hospital mortality was our primary endpoint. Mechanical and electrical complications occurring in-hospital after acute myocardial infarction were secondary endpoints. Results: Only 47% patients received streptokinase while 53% did not receive it because of delayed presentation or some other contraindication to streptokinase therapy. Mean age of the SK group was 51.58±11.02 years and Non-SK group was 55.78±10 years. In SK group 170(83.3%) patients were males and 34(16.7%) were females. Only 54(26.5%) diabetics and 150(73.5%) non-diabetics received streptokinase. Streptokinase recipients reached the hospital earlier; mean time of onset of symptoms till arrival at the hospital was 4 hours and 25 minutes while non-recipients took a longer time in reaching to the hospital. There was no significant difference in the infarct territory between the two groups. The Non-SK group had higher Killip class as compared to SK group on presentation to the hospital. In-hospital mortality was 8.3% in SK group and 24.3% in Non-SK group p

Prognostic role of diagnostic criteria of acute myocardial infarction

Abstract Background The term acute myocardial infarction (AMI) reflects cell death of cardiac myocytes caused by ischaemia. The Fourth Universal Definition of Myocardial Infarction (UDMI) defined AMI by a typical rise and fall in the level of biochemical markers of myocardial necrosis together with criteria of myocardial ischaemia. However, the prognostic role of each single diagnostic criteria has never been explored. Purpose To evaluate the prognostic role of the different diagnostic criteria of AMI according to the Fourth UDMI. Methods We enrolled all consecutive patients with AMI admitted from 2016 to 2019. We used a combination of criteria, according to the current ESC guidelines, to meet the diagnosis, namely the detection of an increase and/or decrease of high-sensitivity cardiac troponin I, with at least one value above the 99th percentile of the upper reference limit and at least one of the following: symptoms of ischaemia; ECG changes (new ST-T changes or new LBBB); development of pathological Q waves in the ECG; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality, in our study evaluated by transthoracic echocardiogram. All-cause mortality and a composite endpoint of all-cause mortality, re-hospitalization for heart failure and myocardial re-infarction were collected. The predictive value of diagnostic criteria alone and its association were evaluated using Kaplan-Meier survival curves and subsequent Cox-regression analysis to find independent predictors of adverse events. Results 2386 patients were evaluated. The median follow-up time was 23.3±14.5 months. The total number of events was 703 (29.3%). Kaplan-Meier curves showed that major adverse cardiac events (MACE) were statistically different depending on the diagnostic criteria of AMI at admission. Particularly, clinical criteria alone showed a better predictive value (p&amp;lt;0.001) than other diagnostic AMI criteria. Multivariable Cox-regression model demonstrated that clinical criteria was the independent predictor of good prognosis in patients with AMI (HR=0.43; CI 95% 0.28–0.67; p&amp;lt;0.001). Conversely, the others diagnostic criteria (electrocardiographic and echocardiographic) and the combination of all diagnostic criteria were not independent prognostic factors of MACE (HR=1.1 CI 95% 0.6–2.4, p=0.6; HR=1.1 CI 95% 0.7–1.2, p=0.6; HR=0.9 CI 95% 0.7–1.0, p=0.8 respectively). Conclusions Our data suggest that the prognosis is considerably better among patients with a diagnosis of AMI if clinical criteria alone are present at admission. We also demonstrated that clinical criteria are a strong prognostic predictor of good outcomes in patients with AMI. We hypothesize that the absence of electrocardiographic and echocardiographic alterations could indirectly indicate a smaller infarct sizes that contribute to patients' outcome. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): None

The relationship between non-alcoholic fatty liver disease and acute coronary syndrome severity: is non-alcoholic fatty liver disease a risk marker of coronary atherosclerotic disease?

Abstract Background/Introduction Non-alcoholic fatty liver disease (NAFLD) has been significantly associated with atherosclerotic disease independent of classical risk factors. However, the role of NAFLD in this context remains unclear. The systemic inflammation described in NAFLD related to liver disease progression may be one factor that can influence the progression and instability of atherosclerotic disease and, consequently, in the clinical characteristics of acute coronary syndrome (ACS). Purpose To assess the potential relationship between NAFLD and ACS severity. Methods We performed a retrospective study in adult patients with ACS who presented to the emergency room of a quaternary care medical centre between March 2015 and March 2016 and selected 99 patients without previously known coronary artery disease or liver disease, without a history of significant alcohol consumption, terminal disease, other acute illness, use of statins, amiodarone, or other steatogenic drugs. The diagnostic criteria for acute myocardial infarction (AMI) with ST-segment elevation (STEMI) were ST elevation ≥1mm in ≥2 contiguous leads (2mm for leads V1 to V3). The acute myocardial infarction without ST-segment elevation (NSTEMI) diagnostic was established in patients who did not meet the criteria for STEMI and who had elevated necrosis markers (creatine kinase-MB isoform and troponin I). Unstable angina (UA) diagnostic was established in patients who did not meet the criteria for STEMI and NSTEMI but had more than three cardiovascular risk factors and typical thoracic pain. The presence of steatosis and its degrees was assessed using ultrasound, and the diagnosis of NAFLD was based on the presence of steatosis and clinical history. Results The diagnosis of UA, NSTEMI and STEMI was established in 40, 33 and 26 patients, respectively, and NAFLD was observed in 30%, 66.6% and 76.9% of these patients. NAFLD patients were 5.8 times more likely to have a diagnosis of AMI than UA (p&amp;lt;0.001), were 7.88 times more likely to have a diagnosis of STEMI than UA (p&amp;lt;0.001) and were 4.7 times more likely to have a diagnosis of NSTEMI than UA (p&amp;lt;0.01). Patients with grades 2 and 3 liver steatosis were 4.2 times more likely to have a diagnosis of AMI than UA (p&amp;lt;0.01) and were 8.2 times more likely to have a diagnosis of STEMI than UA (p&amp;lt;0.01). There was no significant relationship between other variables evaluated and the clinical presentation of ACS. Conclusion(s) In this study, the frequency of AMI presentation in NAFLD patients with ACS was significantly higher than the frequency of UA, suggesting a significant relationship between NAFLD and the severity of ACS, independent of the classic risk factors assessed. The results also suggest that the steatosis degree can proportionally influence this context. Therefore, NAFLD could be considered a potential risk marker for coronary atherosclerotic disease progression and instability. Funding Acknowledgement Type of funding sources: None.

Study the Value of Interleukin-6 As Diagnostic and Predictive marker of Cardiac Events in St Segment Elevation Myocardial Infarction

Abstract Background Owing to major changes in the biomarkers available for diagnosis, criteria for acute myocardial infarction have been revised. The current international consensus definition states that the term acute myocardial infarction (AMI) should be used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischemia. The present guidelines pertain to patients presenting with ischemic symptoms and persistent ST-segment elevation on the electrocardiogram (ECG). Most of these patients will show a typical rise in biomarkers of myocardial necrosis and progress to Q wave myocardial infarction. Separate guidelines have recently been developed by another task force of the ESC (European Society of Cardiology) for patients presenting with ischemic symptoms but without persistent ST segment elevation and for patients undergoing myocardial revascularization in general. Aim of the work The aims of this work are: To assess the diagnostic value of interleukin-6 compared to troponin I in ST segment elevation myocardial infarction. To assess the predictive value of elevated interleukin-6 in ST segment elevation myocardial infarction. Patients This prospective study was included sixty adult patients of both sexes meeting the American Heart Association (AHA) recommendations for diagnosis of ST segment elevation myocardial infarction from those attending the Critical Care Units, Critical Care Medicine Department, Faculty of Medicine, Ain Shams University to be included in the current study. Inclusion Criteria :Patients were fulfilled the criteria of diagnosis of acute coronary syndrome (ACS) and diagnosed as ST segment elevation MI according to American Heart Association (AHA) criteria which include patient ranging between 30 to 70 years and presented with active chest pain. Exclusion Criteria Patients were excluded from the study if they have: (1) Recent myocardial infarction in the last three months. (2) Recent cardiological intervention in the last three months. (3) Recent ischemic cerebrovascular stroke in the last three months. (4) Non ST segment elevation myocardial infarction and unstable angina according to electrocardiographic changes, cardiac markers and clinical condition of the patients. (5) Acute infectious diseases that leads to elevation of troponin I and interleukin-6. (6) Active immunological diseases. (7) Renal impairment. Methods The following data were obtained from each patient: Personal data: name, age, sex, occupation and special habits e.g. smoking. History of present illness regarding to clinical condition: onset, nature, duration, course, progression, characteristic site and radiating areas of the chest pain, relieving and aggravating factors, associated symptoms (as diaphoresis, nausea, vomiting, dyspnea and palpitation) and medication received and their effects. Medical history of diabetes mellitus (DM), hypertension (HTN), and history of ischemic heart disease (IHD). Family history of IHD, DM and HTN. Conclusion From this current study we revealed that: STEMI patients have increased level of interleukin-6 compared to those normal persons. Interleukin-6 may be a potentially useful marker for diagnosis of STEMI. Interleukin-6 may be helpful prognostic value for future cardiac mortality in STEMI patients. The level of interleukin-6 is not affected by the extent of myocardial damage and necrosis. Interleukin-6 is an inflammatory cytokine. Recommendations From this study we recommend the use of interleukin-6 level as good diagnostic marker for diagnosis of ST segment elevation myocardial infarction, Also this study recommend the use of interleukin-6 as good prognostic inflammatory marker in future adverse cardiac events and mortality occur after myocardial infarction STEMI type. Study limitations The results are interpreted in consideration of the small population of patients and short term follow up.

An Unusual Cause of Concordance in the Setting of Left Bundle Branch Block

A 73-year-old female with a past medical history of atrial fibrillation, mechanical mitral valve replacement on warfarin, hypertension and hypothyroidism presented to the emergency department with a fall. She fell and hit her head upon standing up from a seated position. She reported a constant posteriorly located headache along with episodes of nausea and vomiting. She denied chest pain, shortness of breath, syncope and fever. The initial examination showed blood pressure of 107/64mmHg, respiratory rate of 13/Min, pulse of 76/Min, oxygen saturation of 96% and Glascow Coma Scale (GCS) of 13, verbal response 4, motor response 6 and eye response 3. Pupils were round and reactive to light. No focal weakness or sensory loss were noted. The patient’s mental status and GCS progressively worsened for which she eventually was intubated. The patient had a mild leukocytosis of 14.11×109 (4.0-10.0). Her sodium, calcium, magnesium, phosphorus and potassium were normal. International Normalized Ratio (INR) was 2.9. The troponin upon presentation was 0.69ng/ml and trended down throughout the hospitalization. Her EKG showed normal sinus rhythm with a left bundle branch block with ST segment elevation in leads V3 - V5 and concordant ST elevation &gt;1mm in V5. Sgarbossa criteria for acute myocardial infarction in the presence of LBBB was 5 points. Computed tomography (CT) scan of the head without contrast showed large bilateral cerebellar hemorrhages with mild inferior herniation of the cerebellar tonsils. Echocardiogram showed ejection fraction of 55-60% with no wall motion abnormalities. Immediate supportive treatment, including fluids and reversal of anticoagulation with prothrombin complex concentrate and vitamin K were administered. The patient underwent a successful suboccipital decompressive craniotomy.

Myocardial infarction with non-obstructive coronary arteries (MINOCA): approaches to diagnosis and treatment

The official abbreviation MINOCA (myocardial infarction with nonobstructive coronary arteries) appeared for the first time in the clinical guidelines of the European Society of Cardiology (ESC, 2017), which is clinically determined by the presence of universal criteria for acute myocardial infarction (MI) ≥50%. Under the “mask” of this diagnosis hides not only MI as a manifestation of ischemia, but also diseases with other mechanisms of myocardial damage. ESC experts consider MINOCA as a working diagnosis (similar to the diagnosis of heart failure or anemia, which requires further action to clarify), or rather – a syndrome that dictates to the doctor after coronary angiography the need for additional examination and differential diagnosis to identify the cause which leading to this condition. It is noted that MI in MINOCA can be both type 1 (due to myocardial ischemia in the blood supply of the spacecraft with vulnerable atherosclerotic plaque) and type 2 (develops as a result of vasospasm, severe anemia, coronary embolism, arrhythmia etc). MINOCA patients are younger, more often women, and tend to have less cardiovascular risk factors. Two-thirds of MINOCA subjects have ST segment elevation In the article, the authors focus on the causes, recommended diagnostic methods, modern diagnostic algorithms, prognosis and treatment of MI without coronary artery obstruction (MINOCA).

Randomized evaluation of beta blocker and ACE-inhibitor/angiotensin receptor blocker treatment in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA-BAT): Rationale and design

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is common and occurs in 6-8% of all patients fulfilling the diagnostic criteria for acute myocardial infarction (AMI). This paper describes the rationale behind the trial 'Randomized Evaluation of Beta Blocker and ACE-Inhibitor/Angiotensin Receptor Blocker Treatment (ACEI/ARB) of MINOCA patients' (MINOCA-BAT) and the need to improve the secondary preventive treatment of MINOCA patients. METHODS: MINOCA-BAT is a registry-based, randomized, parallel, open-label, multicenter trial with 2:2 factorial design. The primary aim is to determine whether oral beta blockade compared with no oral beta blockade, and ACEI/ARB compared with no ACEI/ARB, reduce the composite endpoint of death of any cause, readmission because of AMI, ischemic stroke or heart failure in patients discharged after MINOCA without clinical signs of heart failure and with left ventricular ejection fraction ≥40%. A total of 3500 patients will be randomized into four groups; e.g. ACEI/ARB and beta blocker, beta blocker only, ACEI/ARB only and neither ACEI/ARB nor beta blocker, and followed for a mean of 4 years. SUMMARY: While patients with MINOCA have an increased risk of serious cardiovascular events and death, whether conventional secondary preventive therapies are beneficial has not been assessed in randomized trials. There is a limited basis for guideline recommendations in MINOCA. Furthermore, studies of routine clinical practice suggest that use of secondary prevention therapies in MINOCA varies considerably. Thus results from this trial may influence future treatment strategies and guidelines specific to MINOCA patients.

Change in matrix metalloproteinase 2, 3, and 9 levels at the time of and after acute atherothrombotic myocardial infarction.

Elevated measures of matrix metalloproteinases (MMPs) are associated with acute myocardial infarction (MI), but it is not known how long these changes persist post-MI or if these measures differ between atherothrombotic versus non-atherothrombotic MI. MMPs-2, 3, and 9 were measured in 80 subjects with acute MI (atherothrombotic and non-atherothrombotic MI) or stable coronary artery disease (CAD). Measurements were made at, the time of acute MI, and > 3-month following acute MI (quiescent phase). Outcome measures were compared between groups and between time of acute MI and quiescent post-MI follow-up using Wilcoxon's and repeated measures analysis of variance. Forty-nine subjects met the criteria for acute MI with clearly defined atherothrombotic (n = 22) and non-atherothrombotic (n = 12) subsets. Fifteen subjects met criteria for stable CAD. MMP-3 was higher in acute MI versus stable CAD subjects at the time of acute MI: (453 vs. 217pg/mL, p = 0.010) but not at quiescent phase follow-up (p > 0.05). MMP-9 was higher in acute MI versus stable CAD subjects at the time of acute MI: (412 vs. 168pg/mL, p = 0.002) but not at the quiescent phase follow-up (p > 0.05). MMP-9 was higher at the time of acute MI versus quiescent phase follow-up in acute MI (412 vs. 213pg/mL, p = 0.001) and atherothrombotic MI specifically (458 vs. 212pg/mL, p = 0.001). No difference in MMP-2, 3, or 9 was observed between atherothrombotic versus non-atherothrombotic MI subgroups. MMPs-3 and 9 are significantly elevated in acute MI verses stable CAD subjects at time of acute MI but not different at quiescent phase follow-up. MMP-9 is elevated at the time of acute MI and specifically in acute atherothrombotic MI at time of MI versus quiescent phase follow-up.

Cardiac Computed Tomography in Troponin-Positive Chest Pain: Sometimes the Answer Lies in the Late Iodine Enhancement or Extracellular Volume Fraction Map

Acute chest pain with elevated cardiac troponin in patients not fulfilling the diagnostic criteria for acute myocardial infarction represents a clinical dilemma. Clear-cut guidelines for the management of these patients are lacking, but the prompt identification of the correct diagnosis is essential

Use of objective evidence of myocardial ischemia to facilitate the diagnostic and prognostic distinction between type 2 myocardial infarction and myocardial injury.

First, describe how acute myocardial infarction criteria are used to diagnose type 1 (T1MI) and 2 (T2MI) myocardial infarction. Second, determine whether subjective or objective criteria are used for T2MI. Third, examine outcomes for T2MI based on the presence or absence of objective evidence of myocardial ischemia compared with myocardial injury. Post-hoc analysis of UTROPIA (NCT02060760), a prospective, observational, cohort study involving 1640 consecutive emergency department patients with serial high-sensitivity cardiac troponin I among whom 74 (4.5%) had T1MI, 103 (6.3%) T2MI, and 245 (15%) myocardial injury. Compared with T1MI, patients with T2MI were less likely to have ischemic symptoms (97% vs. 83%), Q waves (24% vs. 1%), new ST-T wave changes (74% vs. 51%), new regional wall motion abnormality (64% vs. 11%), and a culprit lesion on coronary angiography (59% vs. 0%) (all p <0.05). T2MIs were more likely to be diagnosed using subjective criteria (symptoms alone) than T1MI (42% vs. 12%, p <0.0001). Patients with objective T2MI, but not subjective T2MI, had a two-fold increase in early mortality compared with myocardial injury, with 30- and 60-day hazard ratios (95% confidence interval) of 2.3 (0.9, 6.2) and 2.0 (0.9, 4.7) respectively. Among patients with T2MI, many cases are diagnosed using subjective criteria. The presence of objective evidence of myocardial ischemia may identify a higher-risk group of T2MI patients in whom early outcomes are worse than myocardial injury. Emphasis on using objective evidence of myocardial ischemia to diagnose T2MI may result in a more precise and specific disease definition.

UJI SENSITIVITAS DAN SPESIFISITAS TROPONIN I DAN TROPONIN T SEBAGAI PENANDA BIOKIMIA JANTUNG UNTUK MENEGAKKAN DIAGNOSIS ACUTE MYOCARDIAL INFARCTION (AMI)

Acute coronary syndrome (ACS) is the most common heart disease and has been a leading cause of mortality in Indonesia's and developed countries population aged over 45 years endemic. The diagnosis of ACS is made by fulfilling 2 of 3 WHO criteria: typicalishemic chest pain, electrocardiogram (ECG) changes specific for ACS and the raise of cardiac biochemical markers. Cardiac troponin T(cTnT) or I (cTnI) are two novel biomarkers with high diagnostic sensitivity and specificity for early diagnosis of ACS especially acutemyocardial infarction (AMI). Troponin I and T are proteins of cardiac myofibrils, released into the bloodstream in the death damages ofcardiomyocyte caused by AMI or injury.The level of cTnI will not increased in patients with decreased renal functions, which is distinctfrom cTnT. The aims of study are to define the sensitivity and specificity of cTnI and cTnT to be cardiac biochemical markers for AMIpatients. From 41 subjects; 29 AMI and 12 subjects non AMI patients in Cardiac Intensive Care Units (CICU) and Emergency Room(ER) of Rumah Sakit Dr. Hasan Sadikin (RSHS) Bandung from September to October 2007 was evaluated. Design of the study was cross sectional and quantitative observational study. The cTnI and cTnT assay using the quantitative immunochromatography method.Sensitivity, spesificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) in subjects who met 2 WHO criteria for AMI,Troponin I was 74%, 86%, 96% and 40%. Sensitivity, spesificity, PPV and NPV In subjects who met 3 WHO criteria for AMI, Troponin Iwas 89%, 57%, 62% and 87%. Sensitivity, specificity, PPV and NPV cTnI was 90%, 100% 100 and 80% for diagnosis of AMI. In subjectswho met 2 WHO criteria for AMI, Troponin T Sensitivity, specificity, PPV and NPV has 88%, 71%, 94% and 56%. In subjects who met3 WHO criteria for AMI sensitivity, specificity, PPV and NPV Troponin T was 94%, 35%, 53% and 89%. And Sensitivity, specificity, PPVand NPV Troponin T was 97%, 67%, 88%, and 89% for diagnosis of AMI. Troponin T is more sensitive than troponin I, but troponin Ihas greater specificity than troponin T in AMI. Troponin I is more specific because no influence from renal dysfunction.

The cardiac troponin response following physical exercise in relation to biomarker criteria for acute myocardial infarction; the North Sea Race Endurance Exercise Study (NEEDED) 2013

BackgroundThe aim of this study was to investigate troponin (cTn) dynamics for both genders, compared the different release patterns to the gender specific 99th percentile and to current biomarker criteria for diagnosing myocardial infarction (MI). MethodsSerum was collected from 97 recreational cyclists 24 h before and immediately, 3 and 24 h following a 91-km bike race. hs-cTnI (Abbott) and hs-cTnT (Roche) were measured. Conventional or CT coronary angiography was performed in the 13 participants with the highest hs-cTnI (>140 ng/L). Three subjects with obstructive coronary artery disease were excluded from the statistical analysis. ResultsThere was a significant (p < 0.001) post-race increase in cTnI and cTnT; cTnT peaked immediately, cTnI peaked after 3 h. Relative to the gender specific 99th percentile values, women had the largest increase. The biomarker criteria for MI were met in 76–87% for hs-cTnI, and 96–95% for hs-cTnT (p value <0.05), within the first 3 h post-race. ConclusionPost-race cardiac troponin concentrations exceeded diagnostic criteria for MI in the majority of subjects, more often for hs-cTnT than for hs-cTnI, and more pronounced in women than in men. The current biomarker criteria for MI discriminate poorly between an exercise induced troponin increase and acute MI.

Alexithymia and psychopathology in patients with acute myocardial infarction.

The purpose of this study was to investigate alexithymia in acute myocardial infarction (AMI) patients and its relationship with associated anxious-depressive co-morbidity. We studied 71 participants: 30 consecutive patients with cardiac biomarkers and electrocardiographic criteria for acute myocardial infarction (AMI) in a coronary care unit, with a mean age of 65.23 ± 11.95 years (80% male) and a control group of 41 healthy subjects with a mean age of 62.85 ± 7.83 (46% male). We used the Identification Form (sociodemographic data) and clinical diagnostic, the 20-item Toronto Alexithymia Scale (TAS-20), the Symptom Check List – 90 Revised (SCL-90R) and the Hospital Anxiety and Depression Scale (HADS). Results show that patients with acute myocardial infarction had alexithymia scores significantly higher (P = 0.000) than the control group (60.0 ± 12.8 vs 49.9 ± 8.91) and also higher scores in psychopathological traits screened by the SCL-90R, namely high levels of somatization and depression. We also observed a positive correlation between psychopathological symptoms and alexithymia. A significant prevalence of alexithymia was found in patients with AMI suggesting that psychopathological symptoms have a significant relation with alexithymia. In this clinical setting the deficit of emotion expression points to the need of psychotherapeutic intervention in patients after an AMI event occurs, to improve prognosis and well-being.

Clinical observation of early rehabilitation nursing on the prognosis of patients with acute myocardial infarction effect

To explore the effect of early rehabilitation nursing on the quality of life of patients with acute myocardial infarction. Methods 41 cases of patients with acute myocardial infarction were selected according to the diagnostic criteria of acute myocardial infarction, stable vital signs, and no obvious complications. On the basis of routine nursing care, the system of early rehabilitation nursing care, the development of daily rehabilitation nursing plan. The cardiac function, clinical symptoms, quality of life and average length of stay were observed in 41 patients. Results During hospitalization, 41 patients had no deaths and all patients clinical symptoms significantly reduced; length of hospital stay was significantly decreased; heart function recovered well; the quality of life of patients significantly improved. Conclusion Early rehabilitation nursing care for patients with acute myocardial infarction is conducive to improving the condition, shorten the hospital stay, can greatly improve the quality of life of patients, it is worthy of clinical promotion.