ACE
: angiotensin-converting enzyme
ACS
: acute coronary syndrome
ADP
: adenosine diphosphate
AF
: atrial fibrillation
AMI
: acute myocardial infarction
AV
: atrioventricular
AIDA-4
: Abciximab Intracoronary vs. intravenously Drug Application
APACHE II
: Acute Physiology Aand Chronic

/pdf/esc-guidelines-for-the-management-of-acute-myocardial-vy5rt9aiqe.pdf

ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation : The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

/pdf/2015-esc-guidelines-for-the-management-of-acute-coronary-6did6h5nxk.pdf

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)

ACCF
: American College of Cardiology Foundation
ACS
: acute coronary syndrome
AHA
: American Heart Association
CAD
: coronary artery disease
CABG
: coronary artery bypass grafting
CKMB
: creatine kinase MB isoform
cTn
: cardiac troponin
CT
: computed tomography
CV
: coefficient of variation
ECG
: electrocardiogram
ESC
: European Society of Cardiology
FDG
: fluorodeoxyglucose
h
: hour(s)
HF
: heart failure
LBBB
: left bundle branch block
LV
: left ventricle
LVH
: left ventricular hypertrophy
MI
: myocardial infarction
mIBG
: meta-iodo-benzylguanidine
min
: minute(s)
MONICA
: Multinational MONItoring of trends and determinants in CArdiovascular disease)
MPS
: myocardial perfusion scintigraphy
MRI
: magnetic resonance imaging
mV
: millivolt(s)
ng/L
: nanogram(s) per litre
Non-Q MI
: non-Q wave myocardial infarction
NSTEMI
: non-ST-elevation myocardial infarction
PCI
: percutaneous coronary intervention
PET
: positron emission tomography
pg/mL
: pictogram(s) per millilitre
Q wave MI
: Q wave myocardial infarction
RBBB
: right bundle branch block
sec
: second(s)
SPECT
: single photon emission computed tomography
STEMI
: ST elevation myocardial infarction
ST–T
: ST-segment –T wave
URL
: upper reference limit
WHF
: World Heart Federation
WHO
: World Health Organization

Myocardial infarction (MI) can be recognised by clinical features, including electrocardiographic (ECG) findings, elevated values of biochemical markers (biomarkers) of myocardial necrosis, and by imaging, or may be defined by pathology. It is a major cause of death and disability worldwide. MI may be the first manifestation of coronary artery disease (CAD) or it may occur, repeatedly, in patients with established disease. Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that …

/pdf/third-universal-definition-of-myocardial-infarction-1nbq846anm.pdf

Third universal definition of myocardial infarction

At 12 months, the primary end point — a composite of death from vascular causes, myocardial infarction, or stroke — had occurred in 9.8% of patients receiving ticagrelor as compared with 11.7% of those receiving clopidogrel (hazard ratio, 0.84; 95% confidence interval [CI], 0.77 to 0.92; P<0.001). Predefined hierarchical testing of secondary end points showed significant differences in the rates of other composite end points, as well as myocardial infarction alone (5.8% in the ticagrelor group vs. 6.9% in the clopidogrel group, P = 0.005) and death from vascular causes (4.0% vs. 5.1%, P = 0.001) but not stroke alone (1.5% vs. 1.3%, P = 0.22). The rate of death from any cause was also reduced with ticagrelor (4.5%, vs. 5.9% with clopid ogrel; P<0.001). No significant difference in the rates of major bleeding was found between the ticagrelor and clopidogrel groups (11.6% and 11.2%, respectively; P = 0.43), but ticagrelor was associated with a higher rate of major bleeding not related to coronary-artery bypass grafting (4.5% vs. 3.8%, P = 0.03), including more instances of fatal intracranial bleeding and fewer of fatal bleeding of other types. Conclusions In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rate of overall major bleeding but with an increase in the rate of non– procedure-related bleeding. (ClinicalTrials.gov number, NCT00391872.)

/pdf/ticagrelor-versus-clopidogrel-in-patients-with-acute-44jy79lsmw.pdf

Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes

ABOARD
: Angioplasty to Blunt the Rise of Troponin in Acute Coronary Syndromes Randomized for an Immediate or Delayed Intervention
ACC
: American College of Cardiology
ACE
: angiotensin-converting enzyme
ACS
: acute coronary syndromes
ACT
: activated clotting time
ACUITY
: Acute Catheterization and Urgent Intervention Triage strategY
AF
: atrial fibrillation
AHA
: American Heart Association
APPRAISE
: Apixaban for Prevention of Acute Ischemic Events
aPTT
: activated partial thromboplastin time
ARB
: angiotensin receptor blocker
ARC
: Academic Research Consortium
ATLAS
: Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Aspirin With or Without Thienopyridine Therapy in Subjects with Acute Coronary Syndrome
BARI-2D
: Bypass Angioplasty Revascularization Investigation 2 Diabetes
BMS
: bare-metal stent
BNP
: brain natriuretic peptide
CABG
: coronary bypass graft
CAD
: coronary artery disease
CI
: confidence interval
CK
: creatinine kinase
CKD
: chronic kidney disease
CK-MB
: creatinine kinase myocardial band
COX
: cyclo-oxygenase
CMR
: cardiac magnetic resonance
COMMIT
: Clopidogrel and Metoprolol in Myocardial Infarction Trial
CPG
: Committee for Practice Guidelines
CrCl
: creatinine clearance
CRP
: C-reactive protein
CRUSADE
: Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines
CT
: computed tomography
CURE
: Clopidogrel in Unstable Angina to Prevent Recurrent Events
CURRENT
: Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events
CYP
: cytochrome P450
DAPT
: dual (oral) antiplatelet therapy
DAVIT
: Danish Study Group on Verapamil in Myocardial Infarction Trial
DES
: drug-eluting stent
DTI
: direct thrombin inhibitor
DIGAMI
: Diabetes, Insulin Glucose Infusion in Acute Myocardial Infarction
EARLY-ACS
: Early Glycoprotein IIb/IIIa Inhibition in Non-ST-Segment Elevation Acute Coronary Syndrome
ECG
: electrocardiogram
eGFR
: estimated glomerular filtration rate
ELISA
: Early or Late Intervention in unStable Angina
ESC
: European Society of Cardiology
Factor Xa
: activated factor X
FFR
: fractional flow reserve
FRISC
: Fragmin during Instability in Coronary Artery Disease
GP IIb/IIIa
: glycoprotein IIb/IIIa
GRACE
: Global Registry of Acute Coronary Events
HINT
: Holland Interuniversity Nifedipine/Metoprolol Trial
HIT
: heparin-induced thrombocytopenia
HORIZONS
: Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction
HR
: hazard ratio
hsCRP
: high-sensitivity C-reactive protein
ICTUS
: Invasive vs. Conservative Treatment in Unstable coronary Syndromes
INR
: international normalized ratio
INTERACT
: Integrilin and Enoxaparin Randomized Assessment of Acute Coronary Syndrome Treatment
ISAR-COOL
: Intracoronary Stenting With Antithrombotic Regimen Cooling Off
ISAR-REACT
: Intracoronary stenting and Antithrombotic Regimen- Rapid Early Action for Coronary Treatment
i.v.
: intravenous
LDL-C
: low-density lipoprotein cholesterol
LMWH
: low molecular weight heparin
LV
: left ventricular
LVEF
: left ventricular ejection fraction
MB
: myocardial band
MDRD
: Modification of Diet in Renal Disease
MERLIN
: Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Elevation Acute Coronary Syndromes
MI
: myocardial infarction
MINAP
: Myocardial Infarction National Audit Project
MRI
: magnetic resonance imaging
NNT
: numbers needed to treat
NSAID
: non-steroidal anti-inflammatory drug
NSTE-ACS
: non-ST-elevation acute coronary syndromes
NSTEMI
: non-ST-elevation myocardial infarction
NT-proBNP
: N-terminal prohormone brain natriuretic peptide
OASIS
: Organization to Assess Strategies for Ischaemic Syndromes
OPTIMA
: Optimal Timing of PCI in Unstable Angina
OR
: odds ratio
PCI
: percutaneous coronary intervention
PENTUA
: Pentasaccharide in Unstable Angina
PLATO
: PLATelet inhibition and patient Outcomes
PURSUIT
: Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy
RCT
: randomized controlled trial
RE-DEEM
: Randomized Dabigatran Etexilate Dose Finding Study In Patients With Acute Coronary Syndromes (ACS) Post Index Event With Additional Risk Factors For Cardiovascular Complications Also Receiving Aspirin And Clopidogrel
REPLACE-2
: Randomized Evaluation of PCI Linking Angiomax to reduced Clinical Events
RIKS-HIA
: Register of Information and Knowledge about Swedish Heart Intensive care Admissions
RITA
: Research Group in Instability in Coronary Artery Disease trial
RR
: relative risk
RRR
: relative risk reduction
STE-ACS
: ST-elevation acute coronary syndrome
STEMI
: ST-elevation myocardial infarction
SYNERGY
: Superior Yield of the New Strategy of Enoxaparin, Revascularization and Glycoprotein IIb/IIIa Inhibitors trial
SYNTAX
: SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery
TACTICS
: Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy
TARGET
: Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial
TIMACS
: Timing of Intervention in Patients with Acute Coronary Syndromes
TIMI
: Thrombolysis In Myocardial Infarction
TRITON
: TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel–Thrombolysis In Myocardial Infarction
UFH
: unfractionated heparin
VKA
: vitamin K antagonist
VTE
: venous thrombo-embolism

Guidelines summarize and evaluate all available evidence, at the time of the writing process, on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes but are complements for textbooks and cover the European Society of Cardiology (ESC) Core Curriculum topics. Guidelines and recommendations should help the physicians to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible physician(s).

A great number of Guidelines have been issued in recent years by the ESC as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC website (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for diagnosis, management, and/or prevention of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular treatment options were weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . …

/pdf/esc-guidelines-for-the-management-of-acute-coronary-4kjefocfto.pdf

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

![Graphic][1] 

Myocardial infarction is a major cause of death and disability worldwide. Coronary atherosclerosis is a chronic disease with stable and unstable periods. During unstable periods with activated inflammation in the vascular wall, patients may develop a myocardial infarction. Myocardial infarction may be a minor event in a lifelong chronic disease, it may even go undetected, but it may also be a major catastrophic event leading to sudden death or severe haemodynamic deterioration. A myocardial infarction may be the first manifestation of coronary artery disease, or it may occur, repeatedly, in patients with established disease. Information on myocardial infarction attack rates can provide useful data regarding the burden of coronary artery disease within and across populations, especially if standardized data are collected in a manner that demonstrates the distinction between incident and recurrent events. From the epidemiological point of view, the incidence of myocardial infarction in a population can be used as a proxy for the prevalence of coronary artery disease in that population. Furthermore, the term myocardial infarction has major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world, and it is an outcome measure in clinical trials and observational studies. With these perspectives, myocardial infarction may be defined from a number of different clinical, electrocardiographic, biochemical, imaging, and pathological characteristics.

In the past, a general consensus existed for the clinical syndrome designated as myocardial infarction. In studies of disease prevalence, the World Health Organization (WHO) defined myocardial infarction from symptoms, ECG abnormalities, and enzymes. However, the development of more sensitive and specific serological biomarkers and precise imaging techniques allows detection of ever smaller amounts of myocardial necrosis. Accordingly, current clinical practice, health care delivery systems, as well as epidemiology and clinical trials all require a …

 [1]: /embed/inline-graphic-1.gif

/pdf/universal-definition-of-myocardial-infarction-3uelutsf9u.pdf

Shanti Mendis

Papers

Universal definition of myocardial infarction.