Myocardial infarction redefined—A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction

Alpert, Joseph S.; Antman, Elliott M.; Apple, Fred S.; Armstrong, Paul W.; Bassand, Jean‐Pierre; Luna, Antonio; Beller, George A.; Breithardt, Günter; Chaitman, Bernard R.; Clemmensen, Peter; Falk, Erling; Fishbein, M. C.; Galvani, Marcello; Garson, Arthur; Grines, C.L.; Hamm, C; Nauheim, Bad; Hoppe, Uta C.; Jaffe, Allan S.; Katus, Hugo A.; Kjeksus, J.; Klein, W; Klootwijk, Peter; Lenfant, Claude; Levy, Daniel; Lévy, Ron; Luepker, Russell V.; Marcus, F I; Näslund, Ulf; Öhman, Magnus; Pahlm, Olle; Poole‐Wilson, Philip A.; Popp, Richard L.; Pyörälà, Kalevi; Ravkilde, Jan; Rehnquist, N; Roberts, William C.; Roberts, Rebecca; Roelandt, Jos R.T.C.; Rydén, Lars; Sans, S.; Simoons, Maarten L.; Thygesen, Kristian; Tunstall-Pedoe, H; Underwood, Richard; Uretsky, Barry F.; Werf, F. Van de; Voipio‐Pulkki, Liisa‐Maria; Wagner, Galen S.; Wallentin, Lars; Wijns, William; Wood, D

doi:10.1053/euhj.2000.2305

Cited by 1,401 publications

(151 citation statements)

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“…The demographic and clinical characteristics of study participants are summarised in Table 1. Diagnosis of DM2 was based on the criteria of the American Diabetes Association (18), whereas for IHD participants, diagnosis was established on angiographic documentation, the American College of Cardiology criteria (19) and the Joint European Society of Cardiology and American College of Cardiology Committee consensus (20) (Table 2). Patients with stable angina were not included.…”

Section: Study Populationmentioning

confidence: 99%

TLR4 gene polymorphisms: evidence for protection against type 2 diabetes but not for diabetes-associated ischaemic heart disease

Manolakis

Kapsoritakis

Tiaka³

et al. 2011

European Journal of Endocrinology

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Objective: Several factors either predisposing or protecting from the onset of diabetes mellitus type 2 (DM2) have been proposed. Two specific polymorphisms of toll-like receptor 4 (TLR4; Asp299Gly and Thr399Ile) have recently been identified either as candidate protector genes against DM2 and associated neuropathy or risk alleles for the manifestation of diabetic retinopathy. The impact of these alleles on the risk for ischaemic heart disease (IHD) is controversial while their role in diabetesassociated IHD has never been studied. Design and methods: In order to clarify the potential impact of TLR4 polymorphisms on the predisposition for DM2 as well as on diabetes-related IHD vulnerability, the distribution of the mutant TLR4 Asp299Gly and Thr399Ile alleles in 286 DM2 patients and 413 non-DM2 controls with or without IHD, was examined. Results: Mutant alleles were predominantly detected in 79/413 non-diabetic individuals versus 15/286 DM2 patients (P!0.0001). The rates of positivity for mutant alleles were similar among diabetic patients with or without IHD (7/142 vs 8/144, PO0.1), whereas they proved different among non-diabetic individuals with or without IHD (39/145 vs 40/268, PZ0.004). Following multivariate analysis, the difference between diabetic and non-diabetic subjects, with regard to TLR4 mutations alone, remained significant (PZ0.04). Conclusions: Mutant TLR4 alleles confer protection against DM2. However, their presence does not seem to play any role, protective or aggravating, in the manifestation of IHD either in diabetic or in non-diabetic individuals.

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Section: Study Populationmentioning

confidence: 99%

TLR4 gene polymorphisms: evidence for protection against type 2 diabetes but not for diabetes-associated ischaemic heart disease

Manolakis

Kapsoritakis

Tiaka³

et al. 2011

European Journal of Endocrinology

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“…The average age of patients undergoing cTn testing was 66 years (SD 17.8 years), of whom 51% were , 70 years CJEM N JCMU Presenting characteristics of patients undergoing cTn measurements in the ED 2015;17 (1)old and 51% were female ( Table 1). The most common CTAS score was CTAS 3 or ''urgent,'' which represented 47% of patient visits.…”

Section: Resultsmentioning

confidence: 99%

“…In 2000, the European Society of Cardiology and the American College of Cardiology (ESC/ACC) jointly redefined myocardial necrosis to incorporate cTn assays as a diagnostic determinant. 1 In 2007, the ESC/ACC/ American Heart Association (AHA) updated the definition of myocardial infarction (MI) and advocated a ''rise and/or fall'' of cTn over a 6-to 9-hour time period using the 99th percentile in a reference population as the cutoff for classifying an acute and evolving MI. 2 The definition of MI was again updated in 2012 and remains that, in patients with suspected MI but without ECG STEMI criteria, the cTn level is the discriminating criterion between NSTEMI and UA.…”

Section: Ré Sumémentioning

confidence: 99%

Presenting characteristics of patients undergoing cardiac troponin measurements in the emergency department

Goodman

Kavsak²,

Hill³

et al. 2015

CJEM

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Introduction: Not all patients with suspected acute coronary syndrome (ACS) receiving cardiac troponin (cTn) testing present to the emergency department (ED) with cardiac chest pain. Since elderly patients (age $ 70) have increased morbidity and mortality associated with ACS, complaints other than cardiac chest pain may justify cTn testing. Our primary objective was to characterize the population of ED patients who receive cTn testing. The secondary objective was to determine if elderly patients underwent cTn testing for different presenting complaints than their younger counterparts. Methods: We created an electronic database including Canadian Emergency Department Information Systems (CEDIS) presenting complaints, age, sex, disposition, and Canadian Triage Acuity Scale (CTAS) score, for patients who received cTn testing in three Canadian EDs during 2011. We analyzed the data for patient characteristics and sorted by age (, 70 and $ 70) for further analysis. Results: In the 15,824 included patients, the average age was 66 (51% , 70; 51% female). The most common presenting complaints were cardiac chest pain (n 5 3,267) and shortness of breath (n 5 2,266). The elderly underwent cTn testing for significantly (p , 0.0001) different complaints than their younger counterparts. They more commonly presented with generalized weakness (n 5 898), whereas younger patients more frequently had abdominal pain (n 5 576). Conclusions: Cardiac chest pain and shortness of breath are presenting complaints in one-third of patients undergoing ED cTn testing. The majority of patients undergoing cTn testing did not have typical ACS symptoms. Half of all cTn testing in the ED is on the elderly, who present with different complaints than their younger counterparts.

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“…According to the Braunwald Classification [14], 68 patients met the criteria of Braunwald class IIIB and 17 those of class IIIC unstable angina pectoris. According to the consensus of the ESC/ACC [15], all patients were classified as ACS. Fifty-five percent of all patients had already undergone coronary revascularization procedures during former hospital stays.…”

Section: Methodsmentioning

confidence: 99%

Correlation between ST-T-Segment Changes with Markers of Hemostasis in Patients with Acute Coronary Syndromes

Ehlers

Büttcher²,

Eltzschig³

et al. 2002

Cardiology

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Background: Disturbance of the hemostatic and the inflammatory system plays an important role in the pathophysiology of acute coronary syndromes (ACS). Their markers have been shown to predict further coronary events in patients with ACS. The prognostic value of the admission electrocardiogram (ECG), which is commonly used to evaluate ischemia, was studied previously. We investigated the correlation between serum markers of the hemostatic/inflammatory system and ECG changes in ACS. Methods: A standard 12-lead ECG was obtained from 85 patients with ACS on admission (0d). Markers of the hemostatic and inflammatory system were measured on admission and after 2 days (2d). Results: Patients with ST-T-changes had higher fibrinogen and thrombin-antithrombin III complex (TAT) levels than patients without ECG alterations at both times (fibrinogen: 0d: 492 ± 38 vs. 357 ± 36 mg/dl, p < 0.01; 2d: 633 ± 55 vs. 440 ± 50 mg/dl, p < 0.02; TAT: 0d: 7.2 ± 1.3 vs. 3.6 ± 0.7 µg/l, p < 0.05; 2d: 5.3 ± 0.9 vs. 3.2 ± 0.5 µg/l, p < 0.05). Tissue-type plasminogen activator (TPA) was elevated in patients with ECG changes initially (10.1 ± 0.6 vs. 7.2 ± 0.7 ng/ml, p < 0.02). D-dimers, the acute-phase proteins C-reactive protein, serum amyloid A and the soluble adhesion molecules showed no significance. Conclusions: The data reveal a correlation between electrocardiographic changes and hemostasis in patients with ACS. The association of myocardial damage and a disturbed hemostatic system might stratify patients who are at high risk of suffering further coronary events.

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Myocardial infarction redefined—A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction

Cited by 1,401 publications

References 35 publications

TLR4 gene polymorphisms: evidence for protection against type 2 diabetes but not for diabetes-associated ischaemic heart disease

TLR4 gene polymorphisms: evidence for protection against type 2 diabetes but not for diabetes-associated ischaemic heart disease

Presenting characteristics of patients undergoing cardiac troponin measurements in the emergency department

Correlation between ST-T-Segment Changes with Markers of Hemostasis in Patients with Acute Coronary Syndromes

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