ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

James, Stefan; Atar, Dan; Badano, Luigi P.; Lundqvist, Carina Blomström; Borger, Michael A.; Gershlick, Anthony; Huber, Kurt; Jüni, Peter; Lenzen, Mattie J.; Mahaffey, Kenneth W.; Valgimigli, Marco

doi:10.1093/eurheartj/ehs215

Cited by 4,592 publications

(1,456 citation statements)

References 328 publications

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“…All participants were scanned at the same center and on the same scanner. Diagnosis and treatment of STEMI were as per current guidelines 18, 19. Study exclusion criteria were previous MI and standard recognized contraindications to CMR (eg, ferromagnetic implants, claustrophobia, and estimated glomerular filtration rate <30 mL/min).…”

Section: Methodsmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

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BackgroundWhether the remote myocardium of reperfused ST‐segment elevation myocardial infarction (STEMI) patients plays a part in adverse left ventricular (LV) remodeling remains unclear. We aimed to use automated extracellular volume fraction (ECV) mapping to investigate whether changes in the ECV of the remote (ECVR emote) and infarcted myocardium (ECVI nfarct) impacted LV remodeling.Methods and ResultsForty‐eight of 50 prospectively recruited reperfused STEMI patients completed a cardiovascular magnetic resonance at 4±2 days and 40 had a follow‐up scan at 5±2 months. Twenty healthy volunteers served as controls. Mean segmental values for native T1, T2, and ECV were obtained. Adverse LV remodeling was defined as ≥20% increase in LV end‐diastolic volume. ECVR emote was higher on the acute scan when compared to control (27.9±2.1% vs 26.4±2.1%; P=0.01). Eight patients developed adverse LV remodeling and had higher ECVR emote acutely (29.5±1.4% vs 27.4±2.0%; P=0.01) and remained higher at follow‐up (28.6±1.5% vs 26.6±2.1%; P=0.02) compared to those without. Patients with a higher ECVR emote and a lower myocardial salvage index (MSI) acutely were significantly associated with adverse LV remodeling, independent of T1Remote, T1Core and microvascular obstruction, whereas a higher ECVI nfarct was significantly associated with worse wall motion recovery.Conclusions ECVR emote was increased acutely in reperfused STEMI patients. Those with adverse LV remodeling had higher ECVR emote acutely, and this remained higher at follow‐up than those without adverse LV remodeling. A higher ECVR emote and a lower MSI acutely were significantly associated with adverse LV remodeling whereas segments with higher ECVI nfarct were less likely to recover wall motion.

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Section: Methodsmentioning

confidence: 99%

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Bulluck

Rosmini

Abdel‐Gadir

et al. 2016

JAHA

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“…All patients were admitted for emergency percutaneous coronary intervention (PCI) and treated following European standard protocols 19. In the same procedure we performed diagnostic RA.…”

Section: Methodsmentioning

confidence: 99%

“…We performed coronary angiography via right femoral artery and treated coronary lesions (thrombus aspiration, coronary stenting) as usual 19. Therapeutic decisions were not influenced by study requirements.…”

Section: Methodsmentioning

confidence: 99%

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

Burlacu¹,

Siriopol

Voroneanu

et al. 2015

JAHA

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BackgroundWe are the first to evaluate the prevalence of renal artery stenosis (RAS) in consecutive patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention from a single tertiary center. As a novelty, we assessed hydration and metabolic status and measured arterial stiffness. We elaborated a predicting model for RAS in AMI.Methods and ResultsOne hundred and eighty‐one patients with AMI underwent concomitantly primary percutaneous coronary intervention and renal angiography. We obtained data on demographics, medical history, cardiovascular risk factors, echocardiography, Killip class, and blood tests. In the first 24 hours post–primary percutaneous coronary intervention, we assessed bioimpedance through Body Composition Monitoring® and arterial stiffness through pulsed‐wave velocity, SphygmoCor®. Significant RAS (>50% lumen narrowing, RAS+) was present in 16.6% patients. In the RAS+ group we recorded significantly higher stiffness, CRUSADE score and dehydration, and more women with higher prevalence of multivascular coronary artery disease and heart failure. In our multivariate models, variables independently associated with RAS+ were previous percutaneous coronary intervention, low estimated glomerular filtration rate, multivascular coronary artery disease, and total/extracellular body water. These models had good specificity and low sensitivity.ConclusionsWe observed that RAS+ AMI patients have a particular hydration, metabolic, and endothelial profile that could generate more future major adverse cardiac events. Hence, renal angiography in AMI should be considered in specific subsets of patients.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02388139.

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“…Current treatment guidelines for patients with ACS undergoing percutaneous coronary intervention (PCI) recommend dual antiplatelet therapy (DAPT), a combination of aspirin and a P2Y 12 inhibitor, for at least 12 months after the ACS event 2, 3, 4, 5. Clopidogrel remains the most widely used P2Y 12 inhibitor.…”

Section: Introductionmentioning

confidence: 99%

“…Incremental benefit compared with clopidogrel has been shown with the more potent P2Y 12 inhibitors, prasugrel and ticagrelor, although at the risk of increased noncoronary artery bypass graft (CABG)‐related major bleeding 6, 7. Guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) for patients with non‐ST‐elevation (NSTE)‐ACS and ST‐elevation myocardial infarction (STEMI) recommend the use of ticagrelor or prasugrel over clopidogrel for patients with ACS undergoing PCI who can take these drugs safely 2, 3, 4, 5.…”

Section: Introductionmentioning

confidence: 99%

“Real‐World” Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States

Larmore

Effron

Molife

et al. 2015

Cathet Cardio Intervent

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ObjectivesThe 30‐day clinical outcomes with prasugrel or ticagrelor were compared using a US payer database in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).BackgroundPrasugrel and ticagrelor demonstrated superior efficacy with increased non‐coronary artery bypass graft major bleeding compared with clopidogrel in randomized clinical trials. No direct randomized or observational studies have compared clinical outcomes between prasugrel and ticagrelor.MethodsPatients hospitalized for ACS‐PCI between August 1, 2011 and April 30, 2013 and prescribed prasugrel or ticagrelor were selected. Drug treatment cohorts were propensity matched based upon demographic and clinical characteristics. The primary objective compared 30‐day net adverse clinical events (NACE) in prasugrel‐ and ticagrelor‐treated patients using a prespecified 20% noninferiority margin. Secondary objectives included comparisons of major adverse cardiovascular events (MACE) and major bleeding.ResultsData were available for 16,098 patients (prasugrel, n = 13,134; ticagrelor, n = 2,964). In unmatched cohorts, prasugrel‐treated patients were younger with fewer comorbidities than ticagrelor‐treated patients, and 30‐day NACE rates were 5.6 and 9.3%, respectively (P < 0.001). Following propensity matching, NACE was noninferior (P < 0.001) and 22% lower in prasugrel‐treated than in ticagrelor‐treated patients (RR, 0.78; 95% CI, 0.64–0.94). A 30‐day adjusted MACE (RR, 0.80; 95% CI, 0.64–0.98) and major bleeding (RR, 0.65; 95% CI, 0.45–0.95) were also lower in prasugrel‐treated patients compared with ticagrelor‐treated patients.ConclusionsIn this “real‐world,” retrospective, observational study, physicians appear to preferentially use prasugrel in younger patients with lower risk of bleeding or comorbidities compared with ticagrelor. Following adjustment, clinical outcomes associated with prasugrel use appear as good, if not better, than those associated with ticagrelor in ACS‐PCI patients. © 2015 Wiley Periodicals, Inc.

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ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Cited by 4,592 publications

References 328 publications

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Automated Extracellular Volume Fraction Mapping Provides Insights Into the Pathophysiology of Left Ventricular Remodeling Post–Reperfused ST‐Elevation Myocardial Infarction

Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single‐Center Study (REN‐ACS)—A Single Center, Prospective, Observational Study

“Real‐World” Comparison of Prasugrel With Ticagrelor in Patients With Acute Coronary Syndrome Treated With Percutaneous Coronary Intervention in the United States

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