1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction

Antman, Elliott M.; Brooks, Neil; Califf, Robert M.; Hillis, L. David; Hiratzka, Loren F.; Rapaport, Elliot; Riegel, Bárbara; Smith, E. L.; Weaver, W. Douglas; Gibbons, Raymond J.; Alpert, Joseph S.; Eagle, Kim A.; Gardner, Timothy J.; Garson, Arthur; Gregoratos, Gabriel; Russell, Richard O.; Ryan, Thomas J.; Smith, Sidney C.

doi:10.1016/s0735-1097(99)00351-4

Cited by 602 publications

(148 citation statements)

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“…Further, despite investment of effort and resources, limited reductions in interhospital transfer times have occurred 17. The guidelines for management of patients with STEMI have evolved with the 1996 and 1999 recommendations18 stating that PPCI was an alternative to fibrinolytic therapy for reperfusion and 2004 recommendations2 stating that PPCI was the preferred reperfusion strategy with fibrinolysis being used when timely PPCI could not be delivered. This likely influenced practice patterns and is consistent with the temporal trend we found in our study with increasing use of PPCI and declining fibrinolytic use.…”

Section: Discussionmentioning

confidence: 99%

Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry

Hira

Bhatt

Fonarow

et al. 2016

JAHA

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BackgroundTimely reperfusion after ST‐elevation myocardial infarction (STEMI) improves survival. Guidelines recommend primary percutaneous coronary intervention (PPCI) within 90 minutes of arrival at a PCI‐capable hospital. The alternative is fibrinolysis within 30 minutes for those in those for whom timely transfer to a PCI‐capable hospital is not feasible.Methods and ResultsWe identified STEMI patients receiving reperfusion therapy at 229 hospitals participating in the Get With the Guidelines—Coronary Artery Disease (GWTG‐CAD) database (January 1, 2003 through December 31, 2008). Temporal trends in the use of fibrinolysis and PPCI, its timeliness, and in‐hospital mortality outcomes were assessed. We also assessed predictors of fibrinolysis versus PPCI and compliance with performance measures. Defect‐free care was defined as 100% compliance with all performance measures. We identified 29 190 STEMI patients, of whom 2441 (8.4%) received fibrinolysis; 38.2% of these patients achieved door‐to‐needle times ≤30 minutes. Median door‐to‐needle times increased from 36 to 60 minutes (P=0.005) over the study period. Among PPCI patients, median door‐to‐balloon times decreased from 94 to 64 minutes (P<0.0001) over the same period. In‐hospital mortality was higher with fibrinolysis than with PPCI (4.6% vs 3.3%, P=0.001) and did not change significantly over time. Patients receiving fibrinolysis were less likely to receive defect‐free care compared with their PPCI counterparts.ConclusionsUse of fibrinolysis for STEMI has decreased over time with concomitant worsening of door‐to‐needle times. Over the same time period, use of PPCI increased with improvement in door‐to‐balloon times. In‐hospital mortality was higher with fibrinolysis than with PPCI. As reperfusion for STEMI continues to shift from fibrinolysis to PPCI, it will be critical to ensure that door‐to‐needle times and outcomes do not worsen.

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Section: Discussionmentioning

confidence: 99%

Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry

Hira

Bhatt

Fonarow

et al. 2016

JAHA

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“…[1][2][3][4][5][6][7][8][9][10][11][12] An increased blood level of troponins, particularly that of cTnT, also predicts a less favorable outcome in patients with ACS. [1][2][3][4][5][6][7][8][9][10] The release of cTnT appears to indicate recent thrombotic complication of unstable plaques and identifies patients who might benefit from antithrombotic therapy with low-molecular-weight heparin 13 or glycoporotein IIb/IIIa platelet receptor antagonists. [14][15][16] According to the recent guidelines of several scientific societies, [7][8][9][10] one should measure cTn at admission and several times thereafter in patients suffering a cardiac ischemic event.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] The release of cTnT appears to indicate recent thrombotic complication of unstable plaques and identifies patients who might benefit from antithrombotic therapy with low-molecular-weight heparin 13 or glycoporotein IIb/IIIa platelet receptor antagonists. [14][15][16] According to the recent guidelines of several scientific societies, [7][8][9][10] one should measure cTn at admission and several times thereafter in patients suffering a cardiac ischemic event. An initial rise and subsequent fall of blood levels of cTns (T or I) indicates myocardial infarction (MI).…”

Section: Introductionmentioning

confidence: 99%

“…An initial rise and subsequent fall of blood levels of cTns (T or I) indicates myocardial infarction (MI). [7][8][9][10][11] The normal cTn levels should encompass the values of 99% of a healthy population (mean ± 3 standard deviations [SD]), measured with a technique of good precision. 8,11 These values vary in different laboratories, and there is still no consensus on the best cut-off point values.…”

Section: Introductionmentioning

confidence: 99%

“…8,11 These values vary in different laboratories, and there is still no consensus on the best cut-off point values. [1][2][3][4][5][6][7][8][9][10][11][12] In earlier studies, using a first generation cTnT test, values of ≥ 0.20 or 0.10 µg/l were shown to predict an increased risk of adverse outcome. However, with such a test, Lindahl et al noted that the risk already increased with ≥ 0.06 µg/l cTnT levels.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Classification and risk stratification of patients with acute chest pain using a low discriminatory level of cardiac troponin T

Solymoss

Bourassa

Černáček

et al. 2004

Clinical Cardiology

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SummaryBackground: Cardiac troponins are the biochemical markers of choice for the evaluation of acute coronary syndromes (ACS). Using the first-generation test, most studies related adverse outcome to > 0.20 or 0.10 µg/l cardiac troponin T (cTnT) levels. With the highly sensitive and specific second-and third-generation assays, cTnT is undetectable in most healthy individuals.Hypothesis: We evaluated whether a lower cTnT level, within 24 h of admission, could indicate an increased risk of future complications.Methods: During 1998-1999, clinical data were collected in 260 patients with ACS. Cardiac troponin T was measured at arrival, and 4, 8, and 12-24 h thereafter. The maximum cTnT value was then used to assess, over a 15-month follow-up period, the cumulative risk of death or myocardial infarction (MI), as well as rates of events according to quartiles of cTnT values.Results: Patients with ≤ 0.03 µg/l cTnT levels had the lowest rate of adverse events and the best Kaplan-Meier event-free survival curve. Increasing cTnT levels were associated with stepwise increases in mortality rates and with a constant 10-fold increase in MI rates during follow-up.Conclusions: A low threshold cTnT elevation is recommended to assess the risk of ACS. All cTnT elevations > 0.03 µg/l predict a higher risk of MI during follow-up, whereas increasing values predict mortality in relation to the amount of elevation.

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Early Clinical Outcomes and Routine Management of Patients With Non–ST-Segment Elevation Myocardial Infarction

Becker¹

2001

Arch Intern Med

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1999 update: ACC/AHA guidelines for the management of patients with acute myocardial infarction

Cited by 602 publications

References 64 publications

Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry

Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry

Classification and risk stratification of patients with acute chest pain using a low discriminatory level of cardiac troponin T

Early Clinical Outcomes and Routine Management of Patients With Non–ST-Segment Elevation Myocardial Infarction

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