Triggers and Timing of Acute Coronary Syndromes

Tofler, Geoffrey H.; Kopel, Eran; Klempfner, Robert; Eldar, Michael; Buckley, Thomas; Goldenberg, Ilan

doi:10.1016/j.amjcard.2017.02.022

Cited by 18 publications

(5 citation statements)

References 29 publications

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“…Given the low number of patients with exercise directly prior MI in our study (n=1 <24 hours prior to MI, n=0 during MI), we do not expect that MIs in our exercise cohort were triggered by exercise. However, a previous study showed that if MI was triggered by exercise, in-hospital and 1-year mortality were significantly lower compared with MIs not triggered by exercise 29 31. At least, our observation of lower cardiac biomarker concentrations, among patients who engaged in exercise prior to STEMI, aligns with observations from other studies, which report that exercise prior to STEMI is associated with lower mortality and morbidity following STEMI.…”

Section: Discussionsupporting

confidence: 89%

Association between engagement in exercise training and peak cardiac biomarker concentrations following ST-elevation myocardial infarction

Koning¹,

Bakel²,

Rotbi³

et al. 2023

BMJ Open Sport Exerc Med

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BackgroundRegular exercise training is an important factor in prevention of myocardial infarction (MI). However, little is known whether exercise engagement prior to MI is related to the magnitude of post-MI cardiac biomarker concentrations and clinical outcomes.ObjectivesWe tested the hypothesis that exercise engagement in the week prior MI is related to lower cardiac biomarker concentrations following ST-elevated MI (STEMI).MethodsWe recruited hospitalised STEMI patients and assessed the amount of exercise engagement in the 7 days preceding MI onset using a validated questionnaire. Patients were classified as ‘exercise’ if they performed any vigorous exercise in the week prior MI, or as ‘control’ if they did not. Post-MI peak concentrations of high-sensitive cardiac troponin T (peak-hs-cTnT) and creatine kinase (peak-CK) were examined. We also explored whether exercise engagement prior MI is related to the clinical course (duration of hospitalisation and incidence of in-hospital, 30-day and 6-month major adverse cardiac events (reinfarction, target vessel revascularisation, cardiogenic shock or death)).ResultsIn total, 98 STEMI patients were included, of which 16% (n=16) was classified as ‘exercise’, and 84% (n=82) as ‘control’. Post-MI peak-hs-cTnT and peak-CK concentrations were lower in the exercise group (941 (645–2925) ng/mL; 477 (346–1402) U/L, respectively) compared with controls (3136 (1553–4969) ng/mL, p=0.010; 1055 (596–2019) U/L, p=0.016, respectively). During follow-up, no significant differences were found between both groups.ConclusionEngagement in exercise is associated with lower cardiac biomarker peak concentrations following STEMI. These data could provide further support for the cardiovascular health benefits of exercise training.

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Section: Discussionsupporting

confidence: 89%

Association between engagement in exercise training and peak cardiac biomarker concentrations following ST-elevation myocardial infarction

Koning¹,

Bakel²,

Rotbi³

et al. 2023

BMJ Open Sport Exerc Med

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“…63 Other commonly studied triggers, such as the death of a close person, exceptionally stressful work changes and emotional upset, have also been associated with considerable increases in the risk of both cardiovascular events and death (Figure 1). 29,32,33,60,[124][125][126] For example, it was found in a matched cohort study using the UK primary-care database, which included over 30,000 elderly people with experience of partner bereavement and more than 83,000 matched non-bereavement controls that within a month of the partner's death the risk of cardiovascular disease in the bereaved compared with the non-bereavement group was 2.1-fold for myocardial infarction and 2.4-fold for stroke. 29 Moreover, the bereaved group had a 2.2-fold increased risk of acute coronary syndromes other than myocardial infarction, and a 2.4-fold risk of pulmonary embolism in the first 90 days.…”

Section: Stress and Disease Triggeringmentioning

confidence: 99%

Effects of stress on the development and progression of cardiovascular disease

2017

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Cardiovascular disease remains the leading cause of disease burden globally, which underlies the continuing need to identify new complementary targets for prevention. Over the past 5-10 years, the pooling of multiple data sets into 'mega-studies' has accelerated progress in research on stress as a risk and prognostic factor for cardiovascular disease. Severe stressful experiences in childhood, such as physical abuse and household substance abuse, can damage health and increase the risk of multiple chronic conditions in adulthood. Compared with childhood stress and adulthood classic risk factors, such as smoking, high blood pressure, and high serum cholesterol levels, the harmful effects of stress in adulthood are generally less marked. However, adulthood stress has an important role as a disease trigger in individuals who already have a high atherosclerotic plaque burden, and as a determinant of prognosis and outcome in those with pre-existing cardiovascular or cerebrovascular disease. In real-life settings, mechanistic studies have corroborated earlier laboratory-based observations on stress-related pathophysiological changes that underlie triggering, such as lowered arrhythmic threshold and increased sympathetic activation with related increases in blood pressure, as well as pro-inflammatory and procoagulant responses. In some clinical guidelines, stress is already acknowledged as a target for prevention for people at high overall risk of cardiovascular disease or with established cardiovascular disease. However, few scalable, evidence-based interventions are currently available.

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“…However, it may also occur in other ACS scenarios, such as emotional stress with Takotsubo syndrome (23) or exercise and atherosclerotic plaque rupture (24). Accurate diagnosis is critical, as management of SCAD differs from atherosclerotic ACS, but also challenging, continuing to rely upon recognition of characteristic features on invasive angiography (25). SCAD occurs most commonly in the left anterior descending coronary artery (LAD) and in mid to distal coronary segments (26,27).…”

Section: Clinical Presentationmentioning

confidence: 99%

Optical Coherence Tomography and Coronary Dissection: Precious Tool or Useless Surplus?

Barbieri

d’Errico

Avallone

et al. 2022

Front. Cardiovasc. Med.

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Spontaneous coronary artery dissection (SCAD) is a rare clinical condition, but frequently manifested as acute myocardial infarction. In this particular setting, in recent years, optical coherence tomography (OCT) has been established as a possible diagnostic method due to the high spatial resolution (10–20 μm), which can visualize the different layers of coronary vessels. OCT can better analyze the “binary” or double lumen morphology, typical of this entity. Furthermore, it can identify the entrance breach and the circumferential and longitudinal extension of the lesion. However, we have to emphasize that this technique is not free from complications. OCT could further aggravate a dissection or exacerbate a new intimal tear. Therefore, the use of OCT in the evaluation of SCAD should be defined by balancing the diagnostic benefits versus procedural risks. Moreover, we underline that as SCAD is a rare condition and OCT is a recently introduced technique in clinical practice, limited data is available in literature.

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Triggers and Timing of Acute Coronary Syndromes

Cited by 18 publications

References 29 publications

Association between engagement in exercise training and peak cardiac biomarker concentrations following ST-elevation myocardial infarction

Association between engagement in exercise training and peak cardiac biomarker concentrations following ST-elevation myocardial infarction

Effects of stress on the development and progression of cardiovascular disease

Optical Coherence Tomography and Coronary Dissection: Precious Tool or Useless Surplus?

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