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Diagnosis and Treatment of Myocardial Infarction

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 43308

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Dr. Sebastian Reinstadler

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University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
Interests: acute myocardial infarction; coronary artery disease; magnetic resonance imaging; biomarker

Assoc. Prof. Gert Klug

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Guest Editor

University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
Interests: acute myocardial infarction; magnetic resonance imaging; coronary artery disease; interventional cardiology; acute cardiac care

Prof. Dr. Holger Thiele

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Guest Editor

Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
Interests: acute myocardial infarction; cardiogenic shock; interventional cardiology; structural heart disease; cardiac imaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The diagnosis and treatment of acute coronary syndromes (ACS) has evolved enormously over the last few decades. This had led to a dramatic reduction in mortality and recurrent cardiovascular events in all subtypes of ACS. Despite all these advances, though, there remains a substantial acute as well as chronic risk of mortality and major cardiovascular events following an ACS. The acute mortality risk is particularly high in those presenting with cardiogenic shock or after resuscitation. At the same time, with improvements in early survival after an ACS, the rate of adverse outcomes (in particular, heart failure) in the longer term remains persistently high. The introduction of more sensitive cardiac troponin assays has revolutionized early diagnosis and risk stratification of patients with a suspected ACS. However, it has also led to an increased recognition of myocardial injury in acute illnesses other than ACS. Altogether, there remains an unmet clinical need for further improvements in the diagnosis and subsequent management of ACS patients.

The present Special Issue aims to deepen the latest evidence in the field of ACS focusing on both diagnostic and therapeutic advances. Therefore, we welcome the submission of state-of-the-art review articles as well as cutting-edge original research papers dealing with the topics of diagnostic and therapeutic advances in patients with ACS.

Dr. Sebastian Reinstadler
Assoc. Prof. Gert Klug
Prof. Dr. Holger Thiele
Guest Editors

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Keywords

Acute myocardial infarction
NSTE-ACS
STEMI
Biomarker
Cardiogenic shock
Imaging

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Published Papers (10 papers)

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Editorial

Jump to: Research, Review

3 pages, 171 KiB

Open AccessEditorial

Predictors of Long-Term Outcome in STEMI and NSTEMI—Insights from J-MINUET

by Ivan Lechner, Martin Reindl, Bernhard Metzler and Sebastian J. Reinstadler

J. Clin. Med. 2020, 9(10), 3166; https://doi.org/10.3390/jcm9103166 - 30 Sep 2020

Cited by 6 | Viewed by 2676

Abstract

Although patients with ST-segment elevation myocardial infarction (STEMI) and non-ST- segment elevation myocardial infarction (NSTEMI) share similar risk factors and comparable pathophysiology [...] Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

4 pages, 185 KiB

Open AccessEditorial

Glomerular Filtration Rate as a Predictor of Outcome in Acute Coronary Syndrome Complicated by Atrial Fibrillation

by Domenico Santoro, Guido Gembillo and Giuseppe Andò

J. Clin. Med. 2020, 9(5), 1466; https://doi.org/10.3390/jcm9051466 - 14 May 2020

Cited by 13 | Viewed by 2843

Abstract

The close relationship between kidney and heart is well known. Cardiovascular impairment contributes to the worsening of renal function and kidney failure worsens cardiovascular health. Atrial fibrillation (AF) is a frequent issue in patients with Chronic Kidney Disease (CKD) and several studies have demonstrated that AF impacts negatively on their quality of life and outcomes. Understanding the mechanisms leading to the progression of CKD, new-onset AF and acute myocardial infarction (AMI) is a key issue. The evaluation of Glomerular Filtration Rate (GFR) could make the difference in this equilibrium and suggests specific strategies in the treatment of the population at major risk of cardiovascular events. This intriguing connection paves the way for necessary further investigations. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

Research

Jump to: Editorial, Review

18 pages, 4857 KiB

Open AccessArticle

by Elena de Dios, Cesar Rios-Navarro, Nerea Perez-Sole, Jose Gavara, Victor Marcos-Garces, Enrique Rodríguez, Arturo Carratalá, Maria J. Forner, Jorge Navarro, Maria L. Blasco, Elvira Bondia, Jaime Signes-Costa, Jose M. Vila, Maria J. Forteza, Francisco J. Chorro and Vicente Bodi

J. Clin. Med. 2020, 9(11), 3484; https://doi.org/10.3390/jcm9113484 - 28 Oct 2020

Cited by 8 | Viewed by 3506

Abstract

This study aimed to assess the time course of circulating neutrophil and lymphocyte counts and their ratio (NLR) in ST-segment elevation myocardial infarction (STEMI) and coronavirus disease (COVID)-19 and explore their associations with clinical events and structural damage. Circulating neutrophil, lymphocyte and NLR were sequentially measured in 659 patients admitted for STEMI and in 103 COVID-19 patients. The dynamics detected in STEMI (within a few hours) were replicated in COVID-19 (within a few days). In both entities patients with events and with severe structural damage displayed higher neutrophil and lower lymphocyte counts. In both scenarios, higher maximum neutrophil and lower minimum lymphocyte counts were associated with more events and more severe organ damage. NLR was higher in STEMI and COVID-19 patients with the worst clinical and structural outcomes. A canonical deregulation of the immune response occurs in STEMI and COVID-19 patients. Boosted circulating innate (neutrophilia) and depressed circulating adaptive immunity (lymphopenia) is associated with more events and severe organ damage. A greater understanding of these critical illnesses is pivotal to explore novel alternative therapies. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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13 pages, 1233 KiB

Open AccessArticle

Clinical Characteristics, Treatments, and Outcomes of Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Results from a Multicenter National Registry

by Pawel Gasior, Aneta Desperak, Marek Gierlotka, Krzysztof Milewski, Krystian Wita, Zbigniew Kalarus, Joanna Fluder, Maciej Kazmierski, Paweł E. Buszman, Mariusz Gasior and Wojciech Wojakowski

J. Clin. Med. 2020, 9(9), 2779; https://doi.org/10.3390/jcm9092779 - 27 Aug 2020

Cited by 29 | Viewed by 3657

Abstract

Background: Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). Methods: We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medication management options, outcomes, and readmission causes at 36 months follow-up. Results: Patients in the MINOCA group were younger. Females constituted a greater proportion of patients in the MINOCA group when compared to MI-CAD patients. STEMI during admission was diagnosed less frequently in the MINOCA group when compared to the MI-CAD group. All-cause mortality at 12 months was higher in the MINOCA group (10.94% vs. 9.54%, p < 0.001). At 36 months, there was no difference in the all-cause mortality rates (MINOCA 16.18% vs. MI-CAD 14.93%, p = 0.081). All-cause readmission rates were lower in the MINOCA group when compared to the MI-CAD group at both 12 months (45.19% vs. 54.33%, p < 0.001) and 36 months follow-up (56.42% vs. 66.66%, p < 0.001). Conclusions: This is the first description of the clinical features, treatments, and three-year outcomes in a large population of Polish patients. The main finding of this study was a relatively low rate of MINOCA, with high rates of adverse events both at 12 and 36 months follow-up. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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13 pages, 1814 KiB

Open AccessArticle

Prediction of Long-Term Outcomes in ST-Elevation Myocardial Infarction and Non-ST Elevation Myocardial Infarction with and without Creatinine Kinase Elevation—Post-Hoc Analysis of the J-MINUET Study

by Shigeru Toyoda, Masashi Sakuma, Shichiro Abe, Teruo Inoue, Koichi Nakao, Yukio Ozaki, Kazuo Kimura, Junya Ako, Teruo Noguchi, Satoru Suwa, Kazuteru Fujimoto, Yasuharu Nakama, Takashi Morita, Wataru Shimizu, Yoshihiko Saito, Atsushi Hirohata, Yasuhiro Morita, Atsunori Okamura, Toshiaki Mano, Minoru Wake, Kengo Tanabe, Yoshisato Shibata, Mafumi Owa, Kenichi Tsujita, Hiroshi Funayama, Nobuaki Kokubu, Ken Kozuma, Tetsuya Toubaru, Keijirou Saku, Shigeru Ohshima, Yoshihiro Miyamoto, Hisao Ogawa and Masaharu Ishihara Show full author list Hide full author list

J. Clin. Med. 2020, 9(8), 2667; https://doi.org/10.3390/jcm9082667 - 18 Aug 2020

Cited by 4 | Viewed by 3072

Abstract

Background: A Japanese prospective, nation-wide, multicenter registry (J-MINUET) showed that long-term outcomes were worse in non-ST elevation acute myocardial infarction (NSTEMI), diagnosed by increased cardiac troponin levels, compared to STEMI. This was observed in both non-STEMI with elevated creatine kinase (CK) (NSTEMI+CK) and non-STEMI without elevated CK (NSTEMI-CK). However, predictive factors for long-term outcomes in STEMI, NSTEMI+CK, and NSTEMI-CK have not been elucidated. Methods: Using the Cox proportional hazards model, we determined significant independent predictors of long-term outcomes from a total of 111 parameters evaluated in the J-MINUET study in each of our groups, including STEMI, NSTEMI+CK, and NSTEMI-CK. Then, we calculated the risk score using the regression coefficients for the determined independent predictors for the strict prediction of long-term outcomes. Results: Prognostic factors, as well as composite cardiovascular events and all-cause death, were different between STEMI, NSTEMI+CK, and NSTEMI-CK. Risk scores could effectively and powerfully predict both composite cardiovascular events and all-cause death in each group. Conclusions: The prediction of long-term outcomes using cored parameters of baseline demographics and clinical characteristics is feasible and could prove useful in establishing therapeutic strategies in patients with STEMI, NSTEMI+CK, and NSTEMI-CK. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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10 pages, 1068 KiB

Open AccessArticle

Effect of the COVID-19 Pandemic on Treatment Delays in Patients with ST-Segment Elevation Myocardial Infarction

by Sebastian J. Reinstadler, Martin Reindl, Ivan Lechner, Magdalena Holzknecht, Christina Tiller, Franz Xaver Roithinger, Matthias Frick, Uta C. Hoppe, Peter Jirak, Rudolf Berger, Georg Delle-Karth, Elisabeth Laßnig, Gert Klug, Axel Bauer, Ronald Binder and Bernhard Metzler

J. Clin. Med. 2020, 9(7), 2183; https://doi.org/10.3390/jcm9072183 - 10 Jul 2020

Cited by 53 | Viewed by 4000

Abstract

Coronavirus disease 19 (COVID-19) and its associated restrictions could affect ischemic times in patients with ST-segment elevation myocardial infarction (STEMI). The objective of this study was to investigate the influence of the COVID-19 outbreak on ischemic times in consecutive all-comer STEMI patients. We included consecutive STEMI patients (n = 163, median age: 61 years, 27% women) who were referred to seven tertiary care hospitals across Austria for primary percutaneous coronary intervention between 24 February 2020 (calendar week 9) and 5 April 2020 (calendar week 14). The number of patients, total ischemic times and door-to-balloon times in temporal relation to COVID-19-related restrictions and infection rates were analyzed. While rates of STEMI admissions decreased (calendar week 9/10 (n = 69, 42%); calendar week 11/12 (n = 51, 31%); calendar week 13/14 (n = 43, 26%)), total ischemic times increased from 164 (interquartile range (IQR): 107–281) min (calendar week 9/10) to 237 (IQR: 141–560) min (calendar week 11/12) and to 275 (IQR: 170–590) min (calendar week 13/14) (p = 0.006). Door-to-balloon times were constant (p = 0.60). There was a significant difference in post-interventional Thrombolysis in myocardial infarction (TIMI) flow grade 3 in patients treated during calendar week 9/10 (97%), 11/12 (84%) and 13/14 (81%; p = 0.02). Rates of in-hospital death and re-infarction were similar between groups (p = 0.48). Results were comparable when dichotomizing data on 10 March and 16 March 2020, when official restrictions were executed. In this cohort of all-comer STEMI patients, we observed a 1.7-fold increase in ischemic time during the outbreak of COVID-19 in Austria. Patient-related factors likely explain most of this increase. Counteractive steps are needed to prevent further cardiac collateral damage during the ongoing COVID-19 pandemic. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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14 pages, 609 KiB

Open AccessArticle

Prognostic Impact of Active Mechanical Circulatory Support in Cardiogenic Shock Complicating Acute Myocardial Infarction, Results from the Culprit-Shock Trial

by Hans-Josef Feistritzer, Steffen Desch, Anne Freund, Janine Poess, Uwe Zeymer, Taoufik Ouarrak, Steffen Schneider, Suzanne de Waha-Thiele, Georg Fuernau, Ingo Eitel, Marko Noc, Janina Stepinska, Kurt Huber and Holger Thiele

J. Clin. Med. 2020, 9(6), 1976; https://doi.org/10.3390/jcm9061976 - 24 Jun 2020

Cited by 12 | Viewed by 3452

Abstract

Objectives: To analyze the use and prognostic impact of active mechanical circulatory support (MCS) devices in a large prospective contemporary cohort of patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). Background: Although increasingly used in clinical practice, data on the efficacy and safety of active MCS devices in patients with CS complicating AMI are limited. Methods: This is a predefined subanalysis of the CULPRIT-SHOCK randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups: (1) use of at least one active MCS device vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or renal replacement therapy at 30 days. Results: Two hundred of 1055 (19%) patients received at least one active MCS device (n = 112 Impella^®; n = 95 extracorporeal membrane oxygenation (ECMO); n = 6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared with those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p < 0.001). All-cause mortality and bleeding rates were significantly higher in the active MCS group (all p < 0.001). After multivariable adjustment, the use of active MCS was significantly associated with the primary endpoint (odds ratio (OR) 4.0, 95% confidence interval (CI) 2.7–5.9; p < 0.001). Conclusions: In the CULPRIT-SHOCK trial, active MCS devices were used in approximately one fifth of patients. Patients treated with active MCS devices showed worse outcome at 30 days and 1 year. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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14 pages, 2550 KiB

Open AccessArticle

Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

by Nicola Cosentino, Marco Ballarotto, Jeness Campodonico, Valentina Milazzo, Alice Bonomi, Simonetta Genovesi, Marco Moltrasio, Monica De Metrio, Mara Rubino, Fabrizio Veglia, Emilio Assanelli, Ivana Marana, Marco Grazi, Gianfranco Lauri, Antonio L. Bartorelli and Giancarlo Marenzi

J. Clin. Med. 2020, 9(5), 1396; https://doi.org/10.3390/jcm9051396 - 9 May 2020

Cited by 8 | Viewed by 2496

Abstract

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 (n = 1887): GFR >60; group 2 (n = 492): GFR 60–30; group 3 (n = 66): GFR <30 mL/min/1.73 m²). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively (p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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Review

Jump to: Editorial, Research

19 pages, 3095 KiB

Open AccessReview

Coronary Revascularization and Long-Term Survivorship in Chronic Coronary Syndrome

by Ana Gabaldon-Perez, Victor Marcos-Garces, Jose Gavara, Cesar Rios-Navarro, Gema Miñana, Antoni Bayes-Genis, Oliver Husser, Juan Sanchis, Julio Nunez, Francisco Javier Chorro and Vicente Bodi

J. Clin. Med. 2021, 10(4), 610; https://doi.org/10.3390/jcm10040610 - 5 Feb 2021

Cited by 9 | Viewed by 6208

Abstract

Ischemic heart disease (IHD) persists as the leading cause of death in the Western world. In recent decades, great headway has been made in reducing mortality due to IHD, based around secondary prevention. The advent of coronary revascularization techniques, first coronary artery bypass grafting (CABG) surgery in the 1960s and then percutaneous coronary intervention (PCI) in the 1970s, has represented one of the major breakthroughs in medicine during the last century. The benefit provided by these techniques, especially PCI, has been crucial in lowering mortality rates in acute coronary syndrome (ACS). However, in the setting where IHD is most prevalent, namely chronic coronary syndrome (CCS), the increase in life expectancy provided by coronary revascularization is controversial. Over more than 40 years, several clinical trials have been carried out comparing optimal medical treatment (OMT) alone with a strategy of routine coronary revascularization on top of OMT. Beyond a certain degree of symptomatic improvement and lower incidence of minor events, routine invasive management has not demonstrated a convincing effect in terms of reducing mortality in CCS. Based on the accumulated evidence more than half a century after the first revascularization procedures were used, invasive management should be considered in those patients with uncontrolled symptoms despite OMT or high-risk features related to left ventricular function, coronary anatomy, or functional assessment, taking into account the patient expectations and preferences. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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12 pages, 800 KiB

Open AccessReview

Vasopressors and Inotropes in Acute Myocardial Infarction Related Cardiogenic Shock: A Systematic Review and Meta-Analysis

by Mina Karami, Veemal V. Hemradj, Dagmar M. Ouweneel, Corstiaan A. den Uil, Jacqueline Limpens, Luuk C. Otterspoor, Alexander P. Vlaar, Wim K. Lagrand and José P. S. Henriques

J. Clin. Med. 2020, 9(7), 2051; https://doi.org/10.3390/jcm9072051 - 30 Jun 2020

Cited by 28 | Viewed by 9488

Abstract

Vasopressors and inotropes are routinely used in acute myocardial infarction (AMI) related cardiogenic shock (CS) to improve hemodynamics. We aimed to investigate the effect of routinely used vasopressor and inotropes on mortality in AMI related CS. A systematic search of MEDLINE, EMBASE and CENTRAL was performed up to 20 February 2019. Randomized and observational studies reporting mortality of AMI related CS patients were included. At least one group should have received the vasopressor/inotrope compared with a control group not exposed to the vasopressor/inotrope. Exclusion criteria were case reports, correspondence and studies including only post-cardiac surgery patients. In total, 19 studies (6 RCTs) were included, comprising 2478 CS patients. The overall quality of evidence was graded low. Treatment with adrenaline, noradrenaline, vasopressin, milrinone, levosimendan, dobutamine or dopamine was not associated with a difference in mortality between therapy and control group. We found a trend toward better outcome with levosimendan, compared with control (RR 0.69, 95% CI 0.47–1.00). In conclusion, we found insufficient evidence that routinely used vasopressors and inotropes are associated with reduced mortality in patients with AMI related CS. Considering the limited evidence, this study emphasizes the need for randomized trials with appropriate endpoints and methodology. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Myocardial Infarction)

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