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Circulation. Cardiovascular Quality and... Oct 2022
Review
2022 ACC/AHA Key Data Elements and Definitions for Chest Pain and Acute Myocardial Infarction: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Data Standards.
Topics: United States; Humans; American Heart Association; Myocardial Infarction; Cardiology; Chest Pain
PubMed: 36041014
DOI: 10.1161/HCQ.0000000000000112 -
European Heart Journal. Acute... Apr 2021Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute...
2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group.
AIMS
Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence.
METHODS AND RESULTS
The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores).
CONCLUSION
Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.
Topics: Humans; Myocardial Infarction; Non-ST Elevated Myocardial Infarction; Quality Indicators, Health Care; Risk Assessment; ST Elevation Myocardial Infarction
PubMed: 33550362
DOI: 10.1093/ehjacc/zuaa037 -
Journal of the American College of... Jul 2020
Topics: Coronary Angiography; Heart; Humans; Myocardial Infarction; Young Adult
PubMed: 32674804
DOI: 10.1016/j.jacc.2020.03.088 -
Circulation Journal : Official Journal... 2015
Topics: Blood Glucose; Female; Humans; Magnetic Resonance Imaging; Male; Myocardial Infarction; Radiography; Ventricular Remodeling
PubMed: 25865273
DOI: 10.1253/circj.CJ-15-0339 -
Current Cardiology Reviews Aug 2014The electrocardiogram (ECG) findings in acute coronary syndrome should always be interpreted in the context of the clinical findings and symptoms of the patient, when... (Review)
Review
UNLABELLED
The electrocardiogram (ECG) findings in acute coronary syndrome should always be interpreted in the context of the clinical findings and symptoms of the patient, when these data are available. It is important to acknowledge the dynamic nature of ECG changes in acute coronary syndrome. The ECG pattern changes over time and may be different if recorded when the patient is symptomatic or after symptoms have resolved. Temporal changes are most striking in cases of ST-elevation myocardial infarction. With the emerging concept of acute reperfusion therapy, the concept ST-elevation/ non-ST elevation has replaced the traditional division into Q-wave/non-Q wave in the classification of acute coronary syndrome in the acute phase.
KEYPOINTS
In acute coronary syndrome, in addition to the traditional electrocardiographic risk markers, such as ST depression, the 12-lead ECG contains additional, important diagnostic and prognostic information. Clinical guidelines need to acknowledge certain high-risk ECG patterns to improve patient care.
Topics: Acute Coronary Syndrome; Age Factors; Electrocardiography; Female; Humans; Male; Myocardial Infarction; Prognosis; Sex Factors
PubMed: 24827799
DOI: 10.2174/1573403x10666140514102754 -
BMC Cardiovascular Disorders Apr 2022COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed...
BACKGROUND
COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes.
METHODS
We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January-February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January-February 2020; Group 2, n = 124).
RESULTS
For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001).
CONCLUSIONS
COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment.
Topics: COVID-19; Humans; Myocardial Infarction; Non-ST Elevated Myocardial Infarction; Pandemics; ST Elevation Myocardial Infarction; Time Factors; Treatment Outcome
PubMed: 35473672
DOI: 10.1186/s12872-022-02626-5 -
British Heart Journal Dec 1976Zinc is a metal component of many important enzymes, and its availability controls the rate of synthesis of nucleic acids and protein. Serum zinc levels have been shown...
Zinc is a metal component of many important enzymes, and its availability controls the rate of synthesis of nucleic acids and protein. Serum zinc levels have been shown to fall after acute tissue injury, including myocardial infarction. The purpose of this clinical study was to examine the value of plasma zinc measurements in a coronary care unit. Studies were made in 188 patients: 88 with unequivocal myocardial infarction, 52 controls, and 48 in a borderline group. Patients with myocardial infarction showed a fall in plasma zinc within the first three days, whereas patients in the other two groups did not. The difference in the mean minimum zinc levels between the groups with and without infarction was highly significant. In patients with myocardial infarction there was good correlation between the minimum plasma zinc level and the peal value of plasma enzymes, and also with some clinical estimators of prognosis. A fall in plasma zinc is a reliable diagnostic test for acute myocardial infarction, and the extent of the fall has prognostic implications.
Topics: Humans; Myocardial Infarction; Prognosis; Zinc
PubMed: 1008976
DOI: 10.1136/hrt.38.12.1339 -
The American Journal of Medicine Mar 2022
Topics: Electrocardiography; Humans; Myocardial Infarction; Patient Discharge; Percutaneous Coronary Intervention; ST Elevation Myocardial Infarction
PubMed: 34656529
DOI: 10.1016/j.amjmed.2021.09.013 -
The Journal of Invasive Cardiology May 2022This case illustrates a rare but catastrophic complication of acute myocardial infarction, ie, acute rupture of the left ventricular free wall. The majority of patients...
This case illustrates a rare but catastrophic complication of acute myocardial infarction, ie, acute rupture of the left ventricular free wall. The majority of patients have hemodynamic impairment on arrival, and a high level of suspicion is needed. Point-of-care echocardiogram is valuable for prompt diagnosis. Management is very challenging and is based on fluid infusion, inotropic support, and pericardiocentesis. Emergency coronary artery bypass grafting and ventricular wall suture may be the only definitive treatment available, although in the majority of cases timely treatment is not possible.
Topics: Coronary Artery Bypass; Heart Rupture; Heart Ventricles; Humans; Myocardial Infarction; ST Elevation Myocardial Infarction
PubMed: 35501115
DOI: No ID Found -
Journal of the American College of... May 1996
Topics: Electrocardiography; Humans; Myocardial Infarction; Thrombolytic Therapy; Time Factors
PubMed: 8626940
DOI: 10.1016/0735-1097(96)00007-1