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Kwon S, Park SH, Mun S, Lee J, Kang HG. Potential Biomarkers to Distinguish Type 1 Myocardial Infarction in Troponin-Elevated Diseases. Int J Mol Sci 2023; 24:ijms24098097. [PMID: 37175804 PMCID: PMC10179038 DOI: 10.3390/ijms24098097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Classifying myocardial infarction by subtype is crucial for appropriate patient management. Although troponin is currently the most commonly used biomarker, it is not a specific marker for myocardial infarction and cannot distinguish subtypes. Furthermore, previous studies have confirmed that proteins known as myocardial infarction markers could function to distinguish the type of myocardial infarction. Therefore, we identify a marker that can distinguish type 1 myocardial infarction from other diseases with elevated troponin. We used mass spectrometry to compare type 1 myocardial infarction with other conditions characterized by troponin elevation and identified new candidate markers for disease classification. We then verified these markers, along with those already known to be associated with cardiovascular disease and plaque rupture. We identified α-1 acid glycoprotein 2, corticosteroid-binding globulin, and serotransferrin as potential distinguishing markers. The presence of these markers and other parameters, such as chest pain, electrocardiogram, and troponin levels from the complementary diagnostic processes, could provide valuable information to specifically diagnose type 1 myocardial infarction.
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Affiliation(s)
- Sohyen Kwon
- Department of Senior Healthcare, Graduate School, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Sang-Hyun Park
- Department of Internal Medicine, School of Medicine, Eulji University, Daejeon 34824, Republic of Korea
| | - Sora Mun
- Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Jiyeong Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Hee-Gyoo Kang
- Department of Senior Healthcare, Graduate School, Eulji University, Uijeongbu 11759, Republic of Korea
- Department of Biomedical Laboratory Science, College of Health Sciences, Eulji University, Uijeongbu 11759, Republic of Korea
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Drumright LN, Nance RM, Ruderman SA, Ma J, Whitney BM, Hahn A, Fredericksen RJ, Luu B, Lober WB, Moore RD, Budoff MJ, Keruly JC, Christopoulos K, Puryear S, Willig A, Cropsey K, Mathews WC, Cachay E, Bamford L, Eron JJ, Napravnik S, Mayer KH, O'Cleirigh C, Mccaul ME, Chander G, Feinstein MJ, Saag MS, Kitahata MM, Heckbert SR, Crane HM, Delaney JAC. Associations between alcohol and cigarette use and type 1 and 2 myocardial infarction among people with HIV. HIV Med 2023. [PMID: 36855253 DOI: 10.1111/hiv.13466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES People with HIV have a higher risk of myocardial infarction (MI) than the general population, with a greater proportion of type 2 MI (T2MI) due to oxygen demand-supply mismatch compared with type 1 (T1MI) resulting from atherothrombotic plaque disruption. People living with HIV report a greater prevalence of cigarette and alcohol use than do the general population. Alcohol use and smoking as risk factors for MI by type are not well studied among people living with HIV. We examined longitudinal associations between smoking and alcohol use patterns and MI by type among people living with HIV. DESIGN AND METHODS Using longitudinal data from the Centers for AIDS Research Network of Integrated Clinical Systems cohort, we conducted time-updated Cox proportional hazards models to determine the impact of smoking and alcohol consumption on adjudicated T1MI and T2MI. RESULTS Among 13 506 people living with HIV, with a median 4 years of follow-up, we observed 177 T1MI and 141 T2MI. Current smoking was associated with a 60% increase in risk of both T1MI and T2MI. In addition, every cigarette smoked per day was associated with a 4% increase in risk of T1MI, with a suggestive, but not significant, 2% increase for T2MI. Cigarette use had a greater impact on T1MI for men than for women and on T2MI for women than for men. Increasing alcohol use was associated with a lower risk of T1MI but not T2MI. Frequency of heavy episodic alcohol use was not associated with MI. CONCLUSIONS Our findings reinforce the prioritization of smoking reduction, even without cessation, and cessation among people living with HIV for MI prevention and highlight the different impacts on MI type by gender.
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Affiliation(s)
- Lydia N Drumright
- University of Washington, Seattle, Washington, USA.,University of Cambridge, Cambridge, UK
| | | | | | - Jimmy Ma
- University of Washington, Seattle, Washington, USA
| | | | - Andrew Hahn
- University of Washington, Seattle, Washington, USA
| | | | - Brandon Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | | | | | | | | | | | - Sarah Puryear
- University of California, San Francisco, California, USA
| | | | | | | | - Edward Cachay
- University of California, San Diego, California, USA
| | - Laura Bamford
- University of California, San Diego, California, USA
| | - Joseph J Eron
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sonia Napravnik
- University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | | | - Geetanjali Chander
- University of Washington, Seattle, Washington, USA.,Johns Hopkins University, Baltimore, Maryland, USA
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Luu BR, Nance RM, Delaney JAC, Ruderman SA, Heckbert SR, Budoff MJ, Mathews WC, Moore RD, Feinstein MJ, Burkholder GA, Mugavero MJ, Eron JJ, Saag MS, Kitahata MM, Crane HM, Whitney BM. Brief Report: Insomnia and Risk of Myocardial Infarction Among People With HIV. J Acquir Immune Defic Syndr 2022; 90:50-55. [PMID: 35001042 PMCID: PMC8986570 DOI: 10.1097/qai.0000000000002910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Insomnia is common among people with HIV (PWH) and may be associated with increased risk of myocardial infarction (MI). This study examines the association between insomnia and MI by MI type among PWH. SETTING Longitudinal cohort study of PWH at 5 Centers for AIDS Research Network of Integrated Clinical Systems sites. METHODS Clinical data and patient-reported measures and outcomes from PWH in care between 2005 and 2018 were used in this study. Insomnia, measured at baseline, was defined as having difficulty falling or staying asleep with bothersome symptoms. The Centers for AIDS Research Network of Integrated Clinical Systems centrally adjudicates MIs using expert reviewers, with distinction between type 1 MI (T1MI) and type 2 MI (T2MI). Associations between insomnia and first incident MI by MI type were measured using separate Cox proportional hazard models adjusted for age, sex, race/ethnicity, traditional cardiovascular disease risk factors (hypertension, dyslipidemia, poor kidney function, diabetes, and smoking), HIV markers (antiretroviral therapy, viral suppression, and CD4 cell count), and stimulant use (cocaine/crack and methamphetamine). RESULTS Among 12,448 PWH, 48% reported insomnia. Over a median of 4.4 years of follow-up, 158 T1MIs and 109 T2MIs were identified; approximately half of T2MIs were attributed to sepsis or stimulant use. After adjustment for potential confounders, we found no association between insomnia and T1MI (hazard ratio = 1.05, 95% confidence interval: 0.76 to 1.45) and a 65% increased risk of T2MI among PWH reporting insomnia compared with PWH without insomnia (hazard ratio = 1.65, 95% confidence interval: 1.11 to 2.45). CONCLUSIONS PWH reporting insomnia are at an increased risk of T2MI, but not T1MI, compared with PWH without insomnia, highlighting the importance of distinguishing MI types among PWH.
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Affiliation(s)
- Brandon R Luu
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Robin M Nance
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | | | - Matthew J Budoff
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William C Mathews
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Greer A Burkholder
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Joseph J Eron
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; and
| | - Mari M Kitahata
- Department of Medicine, University of Washington, Seattle, WA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA
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Hoang TH, Lazarev PV, Maiskov VV, Merai IA, Kobalava ZD. Concordance and Prognostic Relevance of Angiographic and Clinical Definitions of Myocardial Infarction Type. J Cardiovasc Pharmacol Ther 2021; 26:463-472. [PMID: 33836638 DOI: 10.1177/10742484211005929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis. METHODS Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed. RESULTS Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had "true" T1MI (atherothrombosis+ / triggers-); 174 (24.4%) were diagnosed with "true" T2MI (atherothrombosis- / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), P = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, P < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, P = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), P = 0.013. CONCLUSION Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients.
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Affiliation(s)
- Truong H Hoang
- Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics, Institute of Medicine, 64948RUDN University, Moscow, Russia
| | - Pavel V Lazarev
- Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics, Institute of Medicine, 64948RUDN University, Moscow, Russia
| | - Victor V Maiskov
- Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics, Institute of Medicine, 64948RUDN University, Moscow, Russia.,Vinogradov Moscow City Clinical Hospital, Moscow, Russia
| | - Imad A Merai
- Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics, Institute of Medicine, 64948RUDN University, Moscow, Russia.,Vinogradov Moscow City Clinical Hospital, Moscow, Russia
| | - Zhanna D Kobalava
- Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics, Institute of Medicine, 64948RUDN University, Moscow, Russia
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5
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Nestelberger T, Lopez-Ayala P, Boeddinghaus J, Strebel I, Rubini Gimenez M, Huber I, Wildi K, Wussler D, Koechlin L, Prepoudis A, Gualandro DM, Puelacher C, Glarner N, Haaf P, Frey S, Bakula A, Wick R, Miró Ò, Martin-Sanchez FJ, Kawecki D, Keller D, Twerenbold R, Mueller C. External Validation and Extension of a Clinical Score for the Discrimination of Type 2 Myocardial Infarction. J Clin Med 2021; 10:1264. [PMID: 33803801 PMCID: PMC8003225 DOI: 10.3390/jcm10061264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The early non-invasive discrimination of Type 2 versus Type 1 Myocardial Infarction (T2MI, T1MI) is a major unmet clinical need. We aimed to externally validate a recently derived clinical score (Neumann) combing female sex, no radiating chest pain, and high-sensitivity cardiac troponin I (hs-cTnI) concentration ≤40.8 ng/L. METHODS Patients presenting with acute chest discomfort to the emergency department were prospectively enrolled into an international multicenter diagnostic study. The final diagnoses of T2MI and T1MI were centrally adjudicated by two independent cardiologists using all information including cardiac imaging and serial measurements of hs-cTnT/I according to the fourth universal definition of MI. Model performance for T2MI diagnosis was assessed by formal tests and graphical means of discrimination and calibration. RESULTS Among 6684 enrolled patients, MI was the adjudicated final diagnosis in 1079 (19%) patients, of which 242 (22%) had T2MI. External validation of the Neumann Score showed a moderate discrimination (C-statistic 0.67 (95%CI 0.64-0.71)). Model calibration showed underestimation of the predicted probabilities of having T2MI for low point scores. Model extension by adding the binary variable heart rate >120/min significantly improved model performance (C-statistic 0.73 (95% CI 0.70-0.76, p < 0.001) and had good calibration. Patients with the highest score values of 3 (Neumann Score, 9.9%) and 5 (Extended Neumann Score, 3.3%) had a 53% and 91% predicted probability of T2MI, respectively. CONCLUSION The Neumann Score provided moderate discrimination and suboptimal calibration. Extending the Neumann Score by adding heart rate >120/min improved the model's performance.
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Affiliation(s)
- Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University Leipzig, 04109 Leipzig, Germany
| | - Iris Huber
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- Critical Care Research Institute, the Prince Charles Hospital, Brisbane and University of Queensland, 4072 Brisbane, Australia
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- Department of Cardiac Surgery, University Hospital Basel, 3010 Basel, Switzerland
| | - Alexandra Prepoudis
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Danielle M. Gualandro
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Noemi Glarner
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Philip Haaf
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
| | - Simon Frey
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
| | - Adam Bakula
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
| | - Rupprecht Wick
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
| | - Òscar Miró
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- Emergency Department, Hospital Clinic, 08036 Barcelona, Spain
| | - F. Javier Martin-Sanchez
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- Servicio de Urgencias, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Damian Kawecki
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Dagmar Keller
- Emergency Department, University Hospital Zurich, 8006 Zurich, Switzerland;
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (T.N.); (P.L.-A.); (J.B.); (I.S.); (M.R.G.); (I.H.); (K.W.); (D.W.); (L.K.); (A.P.); (D.M.G.); (C.P.); (N.G.); (P.H.); (S.F.); (A.B.); (R.W.); (R.T.)
- GREAT Network, 00191 Rome, Italy; (Ò.M.); (F.J.M.-S.); (D.K.)
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6
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Schoepfer H, Nestelberger T, Boeddinghaus J, Twerenbold R, Lopez-Ayala P, Koechlin L, Wussler D, Zimmermann T, Miro O, Martín-Sánchez JF, Christ M, Keller DI, Rubini Gimenez M, Mueller C. Effect of a Proposed Modification of the Type 1 and Type 2 Myocardial Infarction Definition on Incidence and Prognosis. Circulation 2020; 142:2083-2085. [PMID: 33226874 DOI: 10.1161/circulationaha.120.048920] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hadrien Schoepfer
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.).,Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (T.N.)
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Pedro Lopez-Ayala
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Luca Koechlin
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,Department of Cardiac Surgery (L.K.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,Division of Internal Medicine (D.W., T.Z.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Tobias Zimmermann
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,Division of Internal Medicine (D.W., T.Z.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
| | - Oscar Miro
- GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.).,Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.)
| | - Javier F Martín-Sánchez
- GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.).,Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain (J.F.M.-S.)
| | - Michael Christ
- GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.).,Emergency Department Cantonal Hospital of Luzern, Switzerland (M.C.)
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Switzerland (D.I.K.)
| | - Maria Rubini Gimenez
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Germany (M.R.G.)
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland.,GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.)
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7
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Cohen M, Visveswaran G. Defining and managing patients with non-ST-elevation myocardial infarction: Sorting through type 1 vs other types. Clin Cardiol 2020; 43:242-250. [PMID: 31923336 PMCID: PMC7068071 DOI: 10.1002/clc.23308] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022] Open
Abstract
Advances in cardiovascular (CV) imaging, redefined electrocardiogram criteria, and high‐sensitivity CV biomarker assays have enabled more differentiated etiological classification of myocardial infarction (MI). Type 1 MI has a different underlying pathophysiology than type 2 through type 5 MI; type 1 MI is characterized primarily by intracoronary atherothrombosis and the other types by a variety of mechanisms, which can occur with or without an atherosclerotic component. In type 2 MI, there is evidence of myocardial oxygen supply‐demand imbalance unrelated to acute coronary atherothrombosis. Types 1 and 2 MI are spontaneous events, while type 4 and type 5 are procedure‐related; type 3 MI is identified only after death. Most type 1 and type 2 MI present as non‐ST‐elevation MI (NSTEMI), although both types can also present as ST‐elevation MI. Because of their different underlying etiologies, type 1 and type 2 NSTEMI have different presentation and prognosis and should be managed differently. In this article, we discuss the epidemiology, prognosis, and management of NSTEMI occurring in the setting of underlying type 1 or type 2 pathophysiology. Most NSTEMI (65%–90%) are type 1 MI. Patients with type 2 MI have multiple comorbidities and causes of in‐hospital mortality among these patients are not always CV‐related. It is important to distinguish between type 1 and type 2 NSTEMI early in the clinical course to allow for the use of the most appropriate treatments that will provide the greatest benefit for these patients.
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Affiliation(s)
- Marc Cohen
- Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center and Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Gautam Visveswaran
- Division of Cardiology, Department of Medicine, Newark Beth Israel Medical Center and Rutgers-New Jersey Medical School, Newark, New Jersey, USA
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8
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Abstract
INTRODUCTION Troponin is considered to be the gold standard biomarker for ruling out MI. There has been a drive to improve the diagnostic speed, and as such the high sensitivity cardiac troponin (hs-cTn) assays have been introduced into clinical practice and are now part of international guidelines. Their novel value in clinical practice more generally is becoming apparent. Areas covered: In this review we will evaluate the evidence for the use of hs-cTn assays in clinical practice, the issues with the assay and how the hs-cTn can be utilized in the future as a biomarker of cardiovascular risk. Expert commentary: The use of the hs-cTn assays as a 'rule out' test for MI is compelling, as a 'rule in' there are significant issues relating the specificity of the assay for MI. The future of the assay may lie in population screening and risk modeling.
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Affiliation(s)
- Mark Mariathas
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Bartosz Olechowski
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Michael Mahmoudi
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
| | - Nick Curzen
- a Coronary Research Group , University Hospital Southampton NHS Foundation Trust , Southampton , UK.,b Faculty of Medicine , University of Southampton , Southampton , UK
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