Universal Definition of Myocardial Infarction

Thygesen, Kristian; Alpert, Joseph S.; White, Harvey D.

doi:10.1161/circulationaha.107.187397

Cited by 2,769 publications

(1,213 citation statements)

References 97 publications

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“…The recommendation to use cTn as a sole biomarker has remained consistent through the first, second, and third universal definitions of myocardial infarction published in 2000, 2007, and 2012, respectively. The 99th percentile is also recommended by the current American College of Cardiology/American Heart Association guidelines from 2014 2, 3, 8, 9. Despite the recommendations of these groups, we found that a minority of hospitals currently use a cTn‐only strategy, although the proportion has increased substantially.…”

Section: Discussionmentioning

confidence: 64%

“…The 2007 second redefinition of myocardial infarction recommended sampling on presentation followed by 6 to 9 hours, which has been shortened to 3 to 6 hours in the more‐recent recommendations 2, 3, 8. We found that only one third of hospitals’ protocols excluded AMI within 6 hours.…”

Section: Discussionmentioning

confidence: 83%

“…There has been substantial evolution in the use of cardiac biomarkers for diagnosis of AMI 2, 3, 8, 9. To shorten the time to exclusion of AMI, different combinations of markers have been utilized, including various combinations of cTn, CK‐MB, and myoglobin.…”

Section: Discussionmentioning

confidence: 99%

“…To shorten the time to exclusion of AMI, different combinations of markers have been utilized, including various combinations of cTn, CK‐MB, and myoglobin. Because of its superior sensitivity and diagnostic accuracy, cTn is considered the gold‐standard biomarker for risk stratification and diagnosis of AMI 2, 3, 8, 9, 10, 11, 12. The recommendation to use cTn as a sole biomarker has remained consistent through the first, second, and third universal definitions of myocardial infarction published in 2000, 2007, and 2012, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

Hachey

Kontos

Newby

et al. 2017

JAHA

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BackgroundVarious combinations of creatine kinase‐MB, myoglobin, and cardiac troponin I or T (cTnI/cTnT) have been used to evaluate patients with suspected acute coronary syndromes. The current recommendation is to use the 99th percentile of cTnI/cTnT as the sole marker for diagnosis of acute myocardial infarction.Methods and ResultsWe retrospectively analyzed cardiac marker protocols collected from 824 US hospitals undergoing Chest Pain Center Accreditation through the Society of Cardiovascular Patient Care from 2009 to 2014. Data were obtained by a self‐reported survey that addressed cardiac marker(s), sampling time periods, and cut points used for evaluation of suspected acute myocardial infarction. The combination of cTnI or cTnT with creatine kinase‐MB was the most commonly used biomarker strategy. Use of cTnI or cTnT as the sole marker increased over time (14–37%; P<0.0001), as did use of the 99th percentile cut point for cTnI/cTnT (30–60%; P<0.0001).ConclusionThere is considerable variation in cardiac marker testing strategies used in US hospitals for evaluation of suspected acute myocardial infarction. Although increasing, 24% of hospitals used a cTn alone strategy, and only 49% used cTn at the recommended 99th percentile cut point. This has important implications for the diagnosis and treatment of patients with acute myocardial infarction.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

Hachey

Kontos

Newby

et al. 2017

JAHA

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“…Diagnosis of myocardial infarction was made according to the definition proposed by the Joint ESC/ACCF/AHA/WHF Task Force 13. The occurrence of ischemic stroke was determined on clinical manifestations and confirmed by radiological findings; transient ischemic attack was defined according to the Classification of Cerebrovascular Diseases III 14.…”

Section: Methodsmentioning

confidence: 99%

Aging‐Related Decline of Glutathione Peroxidase 3 and Risk of Cardiovascular Events in Patients With Atrial Fibrillation

Pastori

Pignatelli

Farcomeni

et al. 2016

JAHA

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BackgroundExperimental studies demonstrated that glutathione peroxidase 3 (GPx3), an antioxidant enzyme that catabolizes hydrogen peroxide, protects against thrombosis. Little is known about its role in cardiovascular disease.Methods and ResultsA prospective cohort study was conducted in 909 atrial fibrillation patients. Serum activities of GPx3, superoxide dismutase (SOD), and catalase were measured at baseline to assess the risk of cardiovascular events during a mean follow‐up of 43.4 months (3291 person‐years). Serum Nox2 and urinary excretion of 11‐deydro‐thromboxane B2 were also measured. During follow‐up 160 cardiovascular events occurred (4.9%/year). Significantly lower values of GPx3 (P<0.001) and SOD (P=0.037) were detected in patients with, compared to those without, cardiovascular events. A lower survival rate was observed in patients with GPx3 (P<0.001) and SOD (P=0.010) activities below the median, as compared to those above. In a fully adjusted Cox regression model, GPx3 was the only antioxidant enzyme predictor of cardiovascular events (hazard ratio 0.647, 95% confidence interval 0.524‐0.798, P<0.001). GPx3 was inversely associated with urinary 11‐dehydro‐thromboxane B2 (B −0.337, P<0.001) and serum Nox2 (B: −0.423, P<0.001). GPx3 activity progressively decreased with decades of age (P<0.001), with a progressive reduction in people aged ≥70 years.ConclusionsThis study provides evidence that a low antioxidant status, as depicted by reduced levels of GPx3, increases the risk of cardiovascular events in patients with atrial fibrillation. The age‐related decline of GPx3 may represent a mechanism for the enhanced cardiovascular risk in the elderly population.

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Scared to Death? Generalized Anxiety Disorder and Cardiovascular Events in Patients With Stable Coronary Heart Disease

Martens¹,

Jonge²,

Na³

et al. 2010

Arch Gen Psychiatry

217

139

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Universal Definition of Myocardial Infarction

Cited by 2,769 publications

References 97 publications

Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

Trends in Use of Biomarker Protocols for the Evaluation of Possible Myocardial Infarction

Aging‐Related Decline of Glutathione Peroxidase 3 and Risk of Cardiovascular Events in Patients With Atrial Fibrillation

Scared to Death? Generalized Anxiety Disorder and Cardiovascular Events in Patients With Stable Coronary Heart Disease

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