Acute versus chronic myocardial injury and long-term outcomes

Kadesjö, Erik; Roos, Andreas; Siddiqui, Anwar J.; Desta, Liyew; Lundbäck, Magnus; Holzmann, Martin J.

doi:10.1136/heartjnl-2019-315036

Cited by 28 publications

(30 citation statements)

References 27 publications

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“…Troponin elevation is common in conditions other than acute coronary syndromes. A number of studies in both selected and unselected populations suggest that non-ischaemic myocardial injury is the most common cause of elevation in cardiac troponin concentration, [ 9 , 16 , 17 , 18 , 19 ], with more recent studies discriminating between acute and chronic myocardial injury [ 21 , 22 , 23 , 24 ] ( Table 1 ). In an observational cohort study of 22,589 patients who had hs-cTnT measured in a single emergency department (ED) in Sweden [ 22 , 23 ], 65% of those with elevated cardiac troponin concentrations had myocardial injury (30% acute and 35% chronic), with the remaining 35% having a diagnosis of myocardial infarction.…”

Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

“…Most studies demonstrate that cardiovascular death and recurrent myocardial infarction are more common in patients with type 1 myocardial infarction, but patients with both acute and chronic myocardial injury have a substantially higher risk than those without myocardial injury [ 21 , 22 , 23 , 75 ].…”

Section: Clinical Outcomes In Patients With Myocardial Injurymentioning

confidence: 99%

“…A number of studies in both selected and unselected populations suggest that non-ischaemic myocardial injury is the most common cause of elevation in cardiac troponin concentration, [9,[16][17][18][19], with more recent studies discriminating between acute and chronic myocardial injury [21][22][23][24] (Table 1). In an observational cohort study of 22,589 patients who had hs-cTnT measured in a single emergency department (ED) in Sweden [22,23], 65% of those with elevated cardiac troponin concentrations had myocardial injury (30% acute and 35% chronic), with the remaining 35% having a diagnosis of myocardial infarction. The High-Sensitivity Troponin in the Evaluation of Patients with Suspected Acute Coronary Syndrome (High-STEACS) trial evaluated 48,282 consecutive patients with suspected acute coronary syndrome tested using a hs-cTnI assay and demonstrated that of the 9115 patients with elevated cardiac troponin concentrations, 33% had non-ischaemic myocardial injury (18% acute and 12% chronic), with the remaining 67% having a diagnosis of myocardial infarction (50% type 1 and 17% type 2 myocardial infarction).…”

Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

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Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Taggart

Wereski

Mills

2021

JCM

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The application of high-sensitivity cardiac troponins in clinical practice has led to an increase in the recognition of elevated concentrations in patients without myocardial ischaemia. The Fourth Universal Definition of Myocardial Infarction encourages clinicians to classify such patients as having an acute or chronic myocardial injury based on the presence or absence of a rise or a fall in cardiac troponin concentrations. Both conditions may be caused by a variety of cardiac and non-cardiac conditions, and evidence suggests that clinical outcomes are worse than patients with myocardial infarction due to atherosclerotic plaque rupture, with as few as one-third of patients alive at 5 years. Major adverse cardiovascular events are comparable between populations, and up to three-fold higher than healthy individuals. Despite this, no evidence-based strategies exist to guide clinicians in the investigation of non-ischaemic myocardial injury. This review explores the aetiology of myocardial injury and proposes a simple framework to guide clinicians in early assessment to identify those who may benefit from further investigation and treatment for those with cardiovascular disease.

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Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

Section: Clinical Outcomes In Patients With Myocardial Injurymentioning

confidence: 99%

Section: Epidemiology Of Acute and Chronic Myocardial Injurymentioning

confidence: 99%

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Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Taggart

Wereski

Mills

2021

JCM

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“…Acknowledgment of the double-edged mechanism of the inflammation in MI is clinically important as heart failure (HF) patients with reperfusion surgery have poor prognoses. This therefore presents medical practitioners with significant therapeutic challenges (Kadesjö et al, 2019). Results from clinical trials targeting inflammatory factors in MI are inconsistent and not always in line with initial hypotheses.…”

Section: Prevention Of Cardiovascular Events Via Anti-inflammationmentioning

confidence: 99%

“…Ischemic heart diseases, particularly myocardial infarction (MI), remain a primary factor for mortality and morbidity worldwide. A recent observational study of a European cohort revealed similar mortality rates (∼49%) for both acute and chronic MI, highlighting the poor prognosis (Kadesjö et al, 2019). The American Heart Association reported that one third of total deaths for individuals over 35 years of age in the United States were associated with cardiovascular disorder (CVD) (Benjamin et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Mediation of Cardiac Macrophage Activity via Auricular Vagal Nerve Stimulation Ameliorates Cardiac Ischemia/Reperfusion Injury

et al. 2020

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Background: Myocardial infarction (MI) reperfusion therapy causes paradoxical cardiac complications. Following restoration of blood flow to infarcted regions, a multitude of inflammatory cells are recruited to the site of injury for tissue repair. Continual progression of cardiac inflammatory responses does, however, lead to adverse cardiac remodeling, inevitably causing heart failure. Main Body: Increasing evidence of the cardioprotective effects of both invasive and non-invasive vagal nerve stimulation (VNS) suggests that these may be feasible methods to treat myocardial ischemia/reperfusion injury via anti-inflammatory regulation. The mechanisms through which auricular VNS controls inflammation are yet to be explored. In this review, we discuss the potential of autonomic nervous system modulation, particularly via the parasympathetic branch, in ameliorating MI. Novel insights are provided about the activation of the cholinergic anti-inflammatory pathway on cardiac macrophages. Acetylcholine binding to the α7 nicotinic acetylcholine receptor (α7nAChR) expressed on macrophages polarizes the pro-inflammatory into anti-inflammatory subtypes. Activation of the α7nAChR stimulates the signal transducer and activator of transcription 3 (STAT3) signaling pathway. This inhibits the secretion of pro-inflammatory cytokines, limiting ischemic injury in the myocardium and initiating efficient reparative mechanisms. We highlight recent developments in the controversial auricular vagal neuro-circuitry and how they may relate to activation of the cholinergic anti-inflammatory pathway. Conclusion: Emerging published data suggest that auricular VNS is an inexpensive healthcare modality, mediating the dynamic balance between pro-and anti-inflammatory responses in cardiac macrophages and ameliorating cardiac ischemia/reperfusion injury.

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Application of the Universal Definition of Myocardial Infarction in Clinical Practice in Scotland and Sweden

Taggart,

Roos,

Kadesjö

et al. 2024

JAMA Netw Open

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ImportanceWhether the diagnostic classifications proposed by the universal definition of myocardial infarction (MI) to identify type 1 MI due to atherothrombosis and type 2 MI due to myocardial oxygen supply-demand imbalance have been applied consistently in clinical practice is unknown.ObjectiveTo evaluate the application of the universal definition of MI in consecutive patients with possible MI across 2 health care systems.Design, Setting, and ParticipantsThis cohort study used data from 2 prospective cohorts enrolling consecutive patients with possible MI in Scotland (2013-2016) and Sweden (2011-2014) to assess accuracy of clinical diagnosis of MI recorded in hospital records for patients with an adjudicated diagnosis of type 1 or type 2 MI. Data were analyzed from August 2022 to February 2023.Main Outcomes and MeasuresThe main outcome was the proportion of patients with a clinical diagnosis of MI recorded in the hospital records who had type 1 or type 2 MI, adjudicated by an independent panel according to the universal definition. Characteristics and risk of subsequent MI or cardiovascular death at 1 year were compared.ResultsA total of 50 356 patients were assessed. The cohort from Scotland included 28 783 (15 562 men [54%]; mean [SD] age, 60 [17] years), and the cohort from Sweden included 21 573 (11 110 men [51%]; mean [SD] age, 56 [17] years) patients. In Scotland, a clinical diagnosis of MI was recorded in 2506 of 3187 patients with an adjudicated diagnosis of type 1 MI (79%) and 122 of 716 patients with an adjudicated diagnosis of type 2 MI (17%). Similar findings were observed in Sweden, with 970 of 1111 patients with adjudicated diagnosis of type 1 MI (87%) and 57 of 251 patients with adjudicated diagnosis of type 2 MI (23%) receiving a clinical diagnosis of MI. Patients with an adjudicated diagnosis of type 1 MI without a clinical diagnosis were more likely to be women (eg, 336 women [49%] vs 909 women [36%] in Scotland; P &lt; .001) and older (mean [SD] age, 71 [14] v 67 [14] years in Scotland, P &lt; .001) and, when adjusting for competing risk from noncardiovascular death, were at similar or increased risk of subsequent MI or cardiovascular death compared with patients with a clinical diagnosis of MI (eg, 29% vs 18% in Scotland; P &lt; .001).Conclusions and RelevanceIn this cohort study, the universal definition of MI was not consistently applied in clinical practice, with a minority of patients with type 2 MI identified, and type 1 MI underrecognized in women and older persons, suggesting uncertainty remains regarding the diagnostic criteria or value of the classification.

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Acute versus chronic myocardial injury and long-term outcomes

Cited by 28 publications

References 27 publications

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury

Mediation of Cardiac Macrophage Activity via Auricular Vagal Nerve Stimulation Ameliorates Cardiac Ischemia/Reperfusion Injury

Application of the Universal Definition of Myocardial Infarction in Clinical Practice in Scotland and Sweden

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