Third universal definition of myocardial infarction

Thygesen, Kristian; Alpert, Joseph S.; White, Harvey D.; Jaffe, Allan S.; Katus, Hugo A.; Apple, Fred S.; Lindahl, Bertil; Morrow, David A.; Chaitman, Bernard R.; Clemmensen, Peter; Johanson, Per; Hod, Hanoch; Underwood, Richard; Bonow, Robert O.; Pinto, Fausto J.; Gibbons, Raymond J.; Fox, Keith A.A.; Atar, Dan; Newby, L. Kristin; Galvani, Marcello; Hamm, Christian W.; Uretsky, Barry F.; Steg, Philippe Gabriel; Wijns, William; Bassand, Jean‐Pierre; Menasché, P; Ravkilde, Jan; Ohman, E. Magnus; Antman, Elliott M.; Wallentin, Lars; Armstrong, Paul W.; Simoons, Maarten L.; Januzzi, James L.; Nieminen, Markku S.; Gheorghiade, Mihai; Filippatos, Gerasimos; Luepker, Russell V.; Fortmann, Stephen P.; Rosamond, Wayne D.; Levy, Daniel; Wood, David; Smith, Sidney C.; Hu, Dayi; López‐Sendón, José‐Luis; Robertson, Rose Marie; Weaver, Douglas; Bové, Alfred A.; Parkhomenko, Alexander; Vasilieva, Elena; Mendis, Shanthi; Bax, Jeroen J.; Baumgartner, Helmut; Ceconi, Claudio; Dean, Veronica; Deaton, Christi; Fagard, Robert; Funck‐Brentano, Christian; Hasdai, David; Hoes, Arno W.; Kirchhof, Paulus; Knuuti, Juhani; Kolh, Philippe; McDonagh, Theresa A.; Moulin, Cyril; Popescu, Bogdan A.; Reiner, Željko; Sechtem, Udo; Sirnes, Per Anton; Tendera, Michał; Torbicki, Adam; Vahanian, Alec; Windecker, Stephan; Morais, João; Aguíar, Carlos; Almahmeed, Wael; Arnar, Davíð O.; Barili, Fabio; Bloch, Kenneth D.; Bolger, Ann F.; Bøtker, Hans Erik; Bozkurt, Biykem; Bugiardini, Raffaele; Cannon, Christopher P.; Lemos, James A. de; Eberli, Franz R.; Escobar, E; Mark, Daniel B.; James, Stefan; Kern, Karl B.; Moliterno, David J.; Müeller, Christian; Nešković, Aleksandar N.; Pieske, Burkert; Schulman, Steven P.; Storey, Robert F.; Taubert, Kathryn A.; Vranckx, Pascal; Wagner, Daniel R.

doi:10.1093/eurheartj/ehs184

Cited by 2,620 publications

(1,376 citation statements)

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“…The combined end point of MACE consisted of ST‐elevation MI, type I non‐ST‐elevation MI, percutaneous coronary intervention, coronary arterial bypass grafting, and all‐cause death. The diagnosis of MI was made according to the third universal definition of myocardial infarction 23. Diagnoses were adjudicated in retrospect by 2 cardiologists independently (blinded for the assigned HEART scores), taking in consideration all patient information available, including serial troponins and further investigations that were performed during or after the index presentation.…”

Section: Methodsmentioning

confidence: 99%

Sex‐Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain

Bank

Hoog

Kleijn

et al. 2017

JAHA

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BackgroundSex‐based differences in clinical presentation, pathophysiology, and outcomes of patients with acute chest pain are increasingly being recognized, but are not implemented in guidelines and clinical prediction tools. We evaluated the performance of the HEART score in women versus men, because sex‐based differences may exist among the algorithm's components: history, electrocardiogram, age, risk factors, and admission troponin level.Methods and ResultsThe HEART score was retrospectively assessed in 831 women and 1084 men presenting to the emergency department with acute chest pain, assigning patients to the low‐, intermediate‐, or high‐risk category for the occurrence of major adverse cardiac events (MACE) within 6 weeks. MACE, consisting of myocardial infarction, coronary revascularization, and all‐cause death, also included events during index visit. Six‐week MACE rates were 2 times lower in women than men (10.0% versus 20.8%; P<0.01). Despite similar discriminatory accuracy of the HEART score among women and men (c‐statistic, 0.80 [0.75–0.84] versus 0.77 [0.74–0.81]; P=0.43), 6‐week MACE rates were significantly lower in women than men across all HEART risk categories: 2.1% versus 6.5% (P<0.01) in the low‐risk category, 12.7% versus 21.3% (P<0.01) in intermediate‐risk category, and 53.1% versus 77.0% (P=0.02) in the high‐risk category. The HEART score‐adjusted risk ratio for men was 1.6 (1.3–2.0; P<0.01).ConclusionsThe markedly higher 6‐week MACE risk in men across all HEART risk categories should be taken into account when using the HEART score to guide clinical decision making; early discharge with a low‐risk HEART score appears less safe for men than women with acute chest pain.

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Section: Methodsmentioning

confidence: 99%

Sex‐Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain

Bank

Hoog

Kleijn

et al. 2017

JAHA

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“…The prespecified primary end point of the present substudy was the composite of cardiovascular death (defined as any cardiovascular cause of death, sudden death, or any death with no clear attributable noncardiovascular cause), spontaneous MI (defined as non–procedure‐related, nonfatal, MI type 122), or stroke within 1 year of follow‐up 20. The components of the composite end point were also evaluated separately.…”

Section: Methodsmentioning

confidence: 99%

“…and S.K.J. ), comprising cardiologists or neurologists, to subclassify causes of death and to subdivide types of MI, stroke, and bleeding events 20, 22…”

Section: Methodsmentioning

confidence: 99%

Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial

Ueland

Åkerblom

Ghukasyan

et al. 2018

JAHA

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BackgroundElevated levels of osteoprotegerin, a secreted tumor necrosis factor–related molecule, might be associated with adverse outcomes in patients with coronary artery disease. We measured plasma osteoprotegerin concentrations on hospital admission, at discharge, and at 1 and 6 months after discharge in a predefined subset (n=5135) of patients with acute coronary syndromes in the PLATO (Platelet Inhibition and Patient Outcomes) trial.Methods and ResultsThe associations between osteoprotegerin and the composite end point of cardiovascular death, nonprocedural spontaneous myocardial infarction or stroke, and non–coronary artery bypass grafting major bleeding during 1 year of follow‐up were assessed by Cox proportional hazards models. Event rates of the composite end point per increasing quartile groups at baseline were 5.2%, 7.5%, 9.2%, and 11.9%. A 50% increase in osteoprotegerin level was associated with a hazard ratio (HR) of 1.31 (95% confidence interval [CI], 1.21–1.42) for the composite end point but was not significant in adjusted analysis (ie, clinical characteristics and levels of C‐reactive protein, troponin T, NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide], and growth differentiation factor‐15). The corresponding rates of non–coronary artery bypass grafting major bleeding were 2.4%, 2.2%, 3.8%, and 7.2%, with an unadjusted HR of 1.52 (95% CI, 1.36–1.69), and a fully adjusted HR of 1.26 (95% CI, 1.09–1.46). The multivariable association between the osteoprotegerin concentrations and the primary end point after 1 month resulted in an HR of 1.09 (95% CI, 0.89–1.33); for major bleeding after 1 month, the HR was 1.33 (95% CI, 0.91–1.96).ConclusionsIn patients with acute coronary syndrome treated with dual antiplatelet therapy, osteoprotegerin was an independent marker of major bleeding but not of ischemic cardiovascular events. Thus, high osteoprotegerin levels may be useful in increasing awareness of increased bleeding risk in patients with acute coronary syndrome receiving antithrombotic therapy.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00391872.

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“…The diagnosis was based on the universal definition of myocardial infarction [18]. The NPR did not distinguish between ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).…”

Section: Methodsmentioning

confidence: 99%

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

Norum

Hovland

Balteskard

et al. 2017

International Journal of Circumpolar Health

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Patients, relatives, healthcare workers and administrators are concerned about the quality of care offered. We aimed to explore the treatment of acute myocatrdial infarction (AMI) in Northern Norway, compare it with the national figures, and document whether there is an equal quality of care or not. The retrospective study included data on patients' treatment for AMI. The following sources were employed. The Norwegian Patient Registry, National Quality of Care Database, Norwegian Myocardial Infarction Registry and data from the National Air Ambulance Services of Norway. The period 2012-2014/15 was studied and the variables were: incidence of AMI, gender and age adjusted rates of AMI and revascularization (PCI, CABG) based on patient's place of living (according to hospital catchment area) and 30-day survival rate. The annual incidence of AMI was 9% higher in the northern region. Significant incidence variations (2.7–5.9 AMI/1000 inhabitants) between the hospitals' catchment areas were revealed. The 30-day survival rate varied between 85.1–92.1% between hospitals. The variation in revascularization/AMI rate was 0.72–1.54. Air amublance services' availability varied through the day. In conclusion, significant variations in the AMI rate and an unequal service within the region was revealed.

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Third universal definition of myocardial infarction

Cited by 2,620 publications

References 100 publications

Sex‐Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain

Sex‐Based Differences in the Performance of the HEART Score in Patients Presenting to the Emergency Department With Acute Chest Pain

Osteoprotegerin Is Associated With Major Bleeding But Not With Cardiovascular Outcomes in Patients With Acute Coronary Syndromes: Insights From the PLATO (Platelet Inhibition and Patient Outcomes) Trial

Treatment of acute myocardial infarction in the sub-arctic region of Norway. Do we offer an equal quality of care?

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