scholarly journals Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction

2007 ◽  
Vol 28 (20) ◽  
pp. 2525-2538 ◽  
Author(s):  
◽  
K. Thygesen ◽  
J. S. Alpert ◽  
H. D. White ◽  
A. S. Jaffe ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Task Force ◽  
Universal Definition ◽  
Definition Of

scholarly journals Universal Definition of Myocardial Infarction

2007 ◽  
Vol 50 (22) ◽  
pp. 2173-2195 ◽  
Author(s):  
Kristian Thygesen ◽  
Joseph S. Alpert ◽  
Harvey D. White
Keyword(s):  
Myocardial Infarction ◽  
Universal Definition ◽  
Definition Of

scholarly journals Post-infections and sepsis associated myocardial infarction: casuistic masks

2021 ◽  
Vol 16 (7-8) ◽  
pp. 106-109
Author(s):  
L.O. Malsteva ◽  
W.W. Nikonov ◽  
N.A. Kazimirova ◽  
A.A. Lopata
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Task Force ◽  
Laboratory Data ◽  
Myocardial Damage ◽  
Time Frame ◽  
Diagnostic Value ◽  
Epidemiological Studies ◽  
Definition Of ◽  
Post Infectious

The review aims to present the chronological sequence of developing universal definitions of myocardial infarction, new ideas for improving the screening of post-infectious and sepsis-associated myocardial infarction (MI) (casuistic masks of myocardial infarction). The stages of the development of the common and global definition of myocardial infarction are outlined: 1 — by WHO working groups based on ECG for epidemiological studies; 2 — by the European Society of Cardiology and the American College of Cardio-logy using clinical and biochemical approaches; 3 — the Global Task Force consensus document of universal definition with subsequent classification of MI into five subtypes (spontaneous, dissonance in oxygen delivery and consumption; lethal outcome before the rise of specific markers of myocardial damage; PCI-associated; CABG- associated); 4 — review by the Joint Task Force of the above document based on the inclusion of more sensitive markers — troponins; 5 — the allocation of 17 non-ischemic myocardial damage, accompanied by an increase in the level of troponin; 6 — characteristic of the atrial natriuretic peptide from the standpoint of its synthesis, storage, release, diagnostic value as a biomarker of acute myocardial dama­ge; 7 — a clinical definition of myocardial infarction, presented in materials of the III Consensus on myocardial infarction 2017. The diagnosis of myocardial infarction using the criteria set in this document requires the integration of clinical data, ECG patterns, laboratory data, imaging findings, and, in some cases, pathological results, which are considered in the context of the time frame of the suspec­ted event. K. Thygesen et al. consider the additional use of: 1) cardiovascular magnetic resonance to determine the etiology of myocardial damage; 2) computer coronary angiography with suspected myocardial infarction. Myocardial infarction is a combination of specific cardio markers with at least one of the symptoms listed above. The formation of myocardial infarction can occur during/after acute respiratory infection. Causal relationships between these two states are established. Post-infectious myocardial infarction is strongly recommended to be individualized as a separate diagnostic entity. In sepsis, global myocardial ischemia with ischemic myocardial damage arises as a result of humoral and cellular factors, accompanied by an increase in troponins, a decrease in the ejection fraction of the left ventricle by 45 % and an increase in the final diastolic size of the left ventricle, the development of sepsis-associated multiple organ fai­lure, which is an unfavourable prognosis factor.

scholarly journals Myocardial infarction with nonobstructive coronary arteries

Kardiologiia ◽  
2020 ◽  
Vol 60 (3) ◽  
pp. 89-95
Author(s):  
Andrey V. Sherashov ◽  
A. S. Shilova ◽  
E. S. Pershina ◽  
D. Yu. Shchekochikhin ◽  
A. V. Svet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Final Diagnosis ◽  
Individual Case ◽  
Differential Diagnostics ◽  
Special Role ◽  
Disease Etiology ◽  
Magnetic Resonance Imaging Mri ◽  
Universal Definition ◽  
Definition Of

The review focused on a relatively new issue, myocardial infarction with non-obstructive coronary arteries (MINOCA). According to current ideas, almost 6% of all myocardial infarction (MI) cases may be MINOCA. This term can be used both as a “working diagnosis” at the time of further evaluation and a final diagnosis after establishing a cause for each specific case. Since some variants of cardiac, including non-coronary, pathology may be similar to MI in a number of signs, each individual case of MINOCA requires specification. Among major causes for this condition are vasospasm, CA embolism, spontaneous CA dissection, rupture of an eccentric atherosclerotic plaque in a CA, etc. Diagnostics of MINOCA includes both a set of diagnostic tests for verification of the MI diagnosis according to the Fourth Universal Definition of MI and specific studies for elaboration of the disease etiology. A special role in differential diagnostics belongs to gadolinium-enhanced magnetic-resonance imaging (MRI) of the myocardium, which allows to distinguish between MI and non-ischemic myocardial injury of different genesis. Methods of intravascular visualization, such as optical coherence tomography (OCT) and intravascular ultrasound are also important. Commonly accepted guidelines on the treatment of this pathology consistent with current ideas are not available. However, it is obvious that therapeutic possibilities and prognosis for MINOCA depend on the identified cause in each individual case.

Abstract 350: Assessment of Clinicians’ Attitudes and Knowledge About Cardiac Troponin Testing

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sandeep Jain ◽  
Andrew Hammes ◽  
Eric Rudofker ◽  
Karen Ream ◽  
Andrew E Levy
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
Myocardial Injury ◽  
The United States ◽  
Advanced Practice ◽  
Attitudes And Knowledge ◽  
Universal Definition ◽  
Definition Of ◽  
Attending Physicians

In the United States, the positive predictive value (PPV) of cardiac troponin for type 1 myocardial infarction is substantially lower than in Europe (15% vs. 50%). Further, even with publication of the 4 th Universal Definition of Myocardial Infarction, recent studies have shown that inaccurate classification of myocardial injury is common among clinicians in the United States. These findings are at least partly attributable to clinicians’ knowledge and attitudes about cardiac troponin testing; a survey of these parameters has never been conducted. Clinicians at the University of Colorado completed a brief 8-question multiple-choice survey related to troponin use, definitions of myocardial infarction and clinical assessment of elevated troponin levels. The survey was distributed via secure email and administered electronically using the Qualtrics™ platform. Responses were anonymous, completion was estimated to take 3 minutes and a lottery award system was used as an incentive for participation. Respondents included trainees, advanced practice providers and attending physicians from internal medicine, emergency medicine and medical subspecialties. We plan to obtain a total of 300 responses with descriptive findings of preliminary results included below. The survey was completed by 114 clinicians: 37 interns (32%), 45 residents (39%), 9 advanced practice providers (8%), 11 fellows (10%), and 12 attending physicians (11%). Regarding indications for troponin testing, 93% (106/114) indicated that they “usually” or “always” check troponin levels in patients with chest pain. More interestingly, 46% (52/112) reported checking troponin on “undifferentiated patients” at least half the time. For troponin interpretation, 97% (110/114) of participants identified that troponin levels alone cannot rule in or rule out coronary artery disease. In contrast, only 36% (41/114) and 55% (63/114), respectively, identified the NPV and PPV of a contemporary troponin assay for type 1 MI. Further, only 50% (57/114) of respondents identified that the likelihood of type 1 MI increases as troponin levels increase. Three brief clinical vignettes revealed that, while 78% (89/114) and 74% (45/61) of participants, respectively, identified type 1 MI and type 2 MI presentations, only 40% (21/53) of respondents correctly identified a vignette for non-ischemic myocardial injury. Concordant with this finding, 54% (61/114) of clinicians correctly identified the 4 th Universal Definition of Myocardial Infarction. These preliminary findings highlight important facets of clinician attitudes and knowledge about troponin testing that help explain the poor PPV for troponin and diagnostic misclassification observed among U.S. clinicians. These results could help guide curricular and clinical decision support interventions designed to improve the use and interpretation of cardiac troponin testing.

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.

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