2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures

Abstract

This article has been copublished in Circulation: Cardiovascular Quality and Outcomes.

Microvascular obstruction in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: another frontier to conquer?

“…Nevertheless, residual cardiovascular risk persists after STEMI. Efforts are therefore underway to enhance the implementation of existing evidence-based treatments (4,5) and generate novel therapies that prevent and mitigate PCI complications, such as microvascular obstruction (MVO) and the clinical no-reflow phenomenon.…”

“…Consistent with prior smaller studies (7,8) While CMR using late gadolinium enhancement is currently the most sensitive non-invasive imaging modality to assess coronary MVO (7,12,13), it is costly and its overall value as a routine strategy remains unproven. Serial cardiac troponin measurements and left ventricular function assessment (4,5), preferably with a non-invasive modality such as an echocardiogram, should be implemented in all STEMI patients and are clinically-useful surrogates of infarct size. Moreover, MVO can be diagnosed by a myriad of other clinical (e.g., incomplete resolution of ST segment elevation) and angiographic measures (e.g., TIMI myocardial perfusion grade 0 or 1), although these are less sensitive measures and do not provide a reliable quantitative assessment of MVO as CMR.…”

“…Achieving prompt reperfusion is of paramount importance and constant attempts should be undertaken to improve timeliness of reperfusion for STEMI patients presenting to either PCI-capable or non-PCI-capable hospitals (4,5). Optimal blood glucose control prior to primary PCI was shown to lower the risk of no-reflow (14).…”

“…Secondary prevention therapies, such as neuroendocrine inhibitors (e.g., beta blockers, ACE-I/ARB) and high-intensity statin therapy, are recommended by guidelines and constitute performance measures that should be implemented in all STEMI patients (4,5). Based on the current study findings, clinicians may argue that STEMI patients with MVO are at higher intermediate-term risk and may benefit from closer longitudinal follow-up and more aggressive up-titration of evidence-based therapies, although this remains to be proven in future prospective studies.…”

Can soluble ST2 be a new marker in heart failure?

“…In addition, it was suggested in this guideline that during a HF hospitalization, a predischarge natriuretic peptide level can be useful in establishing a post discharge prognosis. Like natriuretic peptides, the cardiac troponin level may be elevated in the setting of chronic or acute decompensated HF, indicating myocyte injury or necrosis [5].…”