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Therapies for Myocardial Injury and Infarction
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Therapies for Myocardial Injury and Infarction

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (20 December 2019) | Viewed by 87925

Special Issue Editor

Prof. Dr. Ingo Eitel

E-Mail Website
Guest Editor
University Heart Center Lübeck, Medical Clinic II – Cardiology, Angiology, Intensive Care Medicine, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
Interests: myocardial infarction; coronary artery disease; atherosclerosis; magnetic resonance imaging; catheterization

Special Issue Information

Dear Colleagues,

Despite marked advances in the diagnosis and management of patients with myocardial infarction (MI), the burden of recurrent cardiovascular events, including mortality, remains high. Acute MI causes more than a third of deaths in developed nations annually. The one-year mortality of unselected patients with ST-segment elevation MI (STEMI) in national registries is around 10%.

The extent of myocardial loss after STEMI (infarct size) is one of the main determinants of post-MI mortality and morbidity, including heart failure. For this reason, experimental and clinical research is focused on potential therapies able to reduce MI size in conjunction with reperfusion. In addition to infarct size, several clinical and preclinical studies have shown that the presence and extent of microvascular obstruction (MVO) represents an important independent predictor of adverse LV remodeling, and recent evidence support the notion that MVO may be more predictive of major adverse cardiovascular events than infarct size itself. Currently, no effective therapies for reducing infarct size or MVO have been translated into improved clinical outcomes, despite tremendous research efforts in this field. This has been suggested to be a consequence of clinical cardioprotection studies performed without robust preclinical data or with a weak study design in terms of patient selection and/or inappropriate timing and mode of delivery of the cardioprotective agent. Moreover, previous cardioprotection studies, mainly aimed at protecting cardiomyocytes and reducing infarct size, neglected other targets for cardioprotection, in particular coronary microcirculation. On the contrary, infarct size and coronary MVO represent two complementary therapeutic targets that should be simultaneously pursued in order to overcome the limitations of previous cardioprotective clinical studies.

Against this background, a panel of international experts with vast expertise in post-MI pathophysiology, cardioprotection, and reperfusion injury will provide new lines of evidence of optimized treatment of myocardial infarction with the main focus to target myocardial injury and coronary microvascular obstruction as the primary treatment goal in myocardial infarction to further improve prognosis. The resulting Special Issue titled “Therapies for Myocardial Injury and Infarction” including original and review articles summarizes the current evidence of myocardial injury including MVO during STEMI and will cover all important aspects from diagnosis, imaging, and treatment up to effectively translating cardioprotective strategies into improved clinical outcomes for infarction patients. All suggested authors have performed numerous trials particularly focusing on cardioprotection and reperfusion injury in order to improve prognosis in STEMI survivors.

Prof. Dr. Ingo Eitel
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Myocardial infarction
  • Myocardial injury
  • Reperfusion injury
  • Cardioprotection
  • Microvascular obstruction
  • Infarct size

Published Papers (15 papers)

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Research

Jump to: Review

10 pages, 1621 KiB  
Article
The Effects of Granulocyte Colony-Stimulating Factor in Patients with a Large Anterior Wall Acute Myocardial Infarction to Prevent Left Ventricular Remodeling: A 10-Year Follow-Up of the RIGENERA Study
by Antonio Maria Leone, Domenico D’Amario, Francesco Cannata, Francesca Graziani, Josip A. Borovac, Giuseppe Leone, Valerio De Stefano, Eloisa Basile, Andrea Siracusano, Leonarda Galiuto, Gabriella Locorotondo, Italo Porto, Rocco Vergallo, Francesco Canonico, Attilio Restivo, Antonio Giuseppe Rebuzzi and Filippo Crea
J. Clin. Med. 2020, 9(4), 1214; https://doi.org/10.3390/jcm9041214 - 23 Apr 2020
Cited by 7 | Viewed by 2727
Abstract
Background: the RIGENERA trial assessed the efficacy of granulocyte-colony stimulating factor (G-CSF) in the improvement of clinical outcomes in patients with severe acute myocardial infarction. However, there is no evidence available regarding the long-term safety and efficacy of this treatment. Methods: in order [...] Read more.
Background: the RIGENERA trial assessed the efficacy of granulocyte-colony stimulating factor (G-CSF) in the improvement of clinical outcomes in patients with severe acute myocardial infarction. However, there is no evidence available regarding the long-term safety and efficacy of this treatment. Methods: in order to evaluate the long-term effects on the incidence of major adverse events, on the symptom burden, on the quality of life and the mean life expectancy and on the left ventricular (LV) function, we performed a clinical and echocardiographic evaluation together with an assessment using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the Seattle Heart Failure Model (SHFM) at 10-years follow-up, in the patients cohorts enrolled in the RIGENERA trial. Results: thirty-two patients were eligible for the prospective clinical and echocardiography analyses. A significant reduction in adverse LV remodeling was observed in G-CSF group compared to controls, 9% vs. 48% (p = 0.030). The New York Heart Association (NYHA) functional class was lower in G-CSF group vs. controls (p = 0.040), with lower burden of symptoms and higher quality of life (p = 0.049). The mean life expectancy was significantly higher in G-CSF group compared to controls (15 ± 4 years vs. 12 ± 4 years, p = 0.046. No difference was found in the incidence of major adverse events. Conclusions: this longest available follow-up on G-CSF treatment in patients with severe acute myocardial infarction (AMI) showed that this treatment was safe and associated with a reduction of adverse LV remodeling and higher quality of life, in comparison with standard-of-care treatment. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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13 pages, 1163 KiB  
Article
A Novel Predictive Model for In-Hospital Mortality Based on a Combination of Multiple Blood Variables in Patients with ST-Segment-Elevation Myocardial Infarction
by Yuhei Goriki, Atsushi Tanaka, Kensaku Nishihira, Atsushi Kawaguchi, Masahiro Natsuaki, Nozomi Watanabe, Keiichi Ashikaga, Nehiro Kuriyama, Yoshisato Shibata and Koichi Node
J. Clin. Med. 2020, 9(3), 852; https://doi.org/10.3390/jcm9030852 - 20 Mar 2020
Cited by 11 | Viewed by 3585
Abstract
In emergency clinical settings, it may be beneficial to use rapidly measured objective variables for the risk assessment for patient outcome. This study sought to develop an easy-to-measure and objective risk-score prediction model for in-hospital mortality in patients with ST-segment elevation myocardial infarction [...] Read more.
In emergency clinical settings, it may be beneficial to use rapidly measured objective variables for the risk assessment for patient outcome. This study sought to develop an easy-to-measure and objective risk-score prediction model for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 1027 consecutive STEMI patients were recruited and divided into derivation (n = 669) and validation (n = 358) cohorts. A risk-score model was created based on the combination of blood test parameters obtained immediately after admission. In the derivation cohort, multivariate analysis showed that the following 5 variables were significantly associated with in-hospital death: estimated glomerular filtration rate <45 mL/min/1.73 m2, platelet count <15 × 104/μL, albumin ≤3.5 g/dL, high-sensitivity troponin I >1.6 ng/mL, and blood sugar ≥200 mg/dL. The risk score was weighted for those variables according to their odds ratios. An incremental change in the scores was significantly associated with elevated in-hospital mortality (p < 0.001). Receiver operating characteristic curve analysis showed adequate discrimination between patients with and without in-hospital death (derivation cohort: area under the curve (AUC) 0.853; validation cohort: AUC 0.879), and there was no significant difference in the AUC values between the laboratory-based and Global Registry of Acute Coronary Events (GRACE) score (p = 0.721). Thus, our laboratory-based model might be helpful in objectively and accurately predicting in-hospital mortality in STEMI patients. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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10 pages, 270 KiB  
Article
High-Sensitivity Troponin T Testing: Consequences on Daily Clinical Practice and Effects on Diagnosis of Myocardial Infarction
by Christian Frédéric Zachoval, Ramona Dolscheid-Pommerich, Ingo Graeff, Bernd Goldschmidt, Andreas Grigull, Birgit Stoffel-Wagner, Georg Nickenig and Sebastian Zimmer
J. Clin. Med. 2020, 9(3), 775; https://doi.org/10.3390/jcm9030775 - 12 Mar 2020
Cited by 5 | Viewed by 2441
Abstract
It remains unclear how introduction of high-sensitivity troponin T testing, as opposed to conventional troponin testing, has affected the diagnosis of acute myocardial infarction (AMI) and resource utilization in unselected hospitalized patients. In this retrospective analysis, we include all consecutive cases from our [...] Read more.
It remains unclear how introduction of high-sensitivity troponin T testing, as opposed to conventional troponin testing, has affected the diagnosis of acute myocardial infarction (AMI) and resource utilization in unselected hospitalized patients. In this retrospective analysis, we include all consecutive cases from our center during two corresponding time frames (10/2016–04/2017 and 10/2017–04/2018) for which different troponin tests were performed: conventional troponin I (cTnI) and high-sensitivity troponin T (hs-TnT) assays. Testing was performed in 18,025 cases. The incidence of troponin levels above the 99th percentile was significantly higher in cases tested using hs-TnT. This was not associated with increased utilization of echocardiography, coronary angiography, or percutaneous coronary intervention. Although there were no changes in local standard operating procedures, study site personnel, or national coding guidelines, the number of coded AMI significantly decreased after introduction of hs-TnT. In this single-center retrospective study comprising 18,025 mixed medical and surgical cases with troponin testing, the introduction of hs-TnT was not associated with changes in resource utilization among the general cohort, but instead, led to a decrease in the international classification of diseases (ICD)-10 coded diagnosis of AMI. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
12 pages, 1254 KiB  
Article
Impact of Morphine Treatment on Infarct Size and Reperfusion Injury in Acute Reperfused ST-Elevation Myocardial Infarction
by Ingo Eitel, Juan Wang, Thomas Stiermaier, Georg Fuernau, Hans-Josef Feistritzer, Alexander Joost, Alexander Jobs, Moritz Meusel, Christian Blodau, Steffen Desch, Suzanne de Waha-Thiele, Harald Langer and Holger Thiele
J. Clin. Med. 2020, 9(3), 735; https://doi.org/10.3390/jcm9030735 - 9 Mar 2020
Cited by 14 | Viewed by 5835
Abstract
Current evidence regarding the effect of intravenous morphine administration on reperfusion injury and/or cardioprotection in patients with myocardial infarction is conflicting. The aim of this study was to evaluate the impact of morphine administration, on infarct size and reperfusion injury assessed by cardiac [...] Read more.
Current evidence regarding the effect of intravenous morphine administration on reperfusion injury and/or cardioprotection in patients with myocardial infarction is conflicting. The aim of this study was to evaluate the impact of morphine administration, on infarct size and reperfusion injury assessed by cardiac magnetic resonance imaging (CMR) in a large multicenter ST-elevation myocardial infarction (STEMI) population. In total, 734 STEMI patients reperfused by primary percutaneous coronary intervention <12 h after symptom onset underwent CMR imaging at eight centers for assessment of myocardial damage. Intravenous morphine administration was recorded in all patients. CMR was completed within one week after infarction using a standardized protocol. The clinical endpoint of the study was the occurrence of major adverse cardiac events (MACE) within 12 months after infarction. Intravenous morphine was administered in 61.8% (n = 454) of all patients. There were no differences in infarct size (17%LV, interquartile range [IQR] 8–25%LV versus 16%LV, IQR 8–26%LV, p = 0.67) and microvascular obstruction (p = 0.92) in patients with versus without morphine administration. In the subgroup of patients with early reperfusion within 120 min and reduced flow of the infarcted vessel (TIMI-flow ≤2 before PCI) morphine administration resulted in significantly smaller infarcts (12%LV, IQR 12–19 versus 19%LV, IQR 10–29, p = 0.035) and reduced microvascular obstruction (p = 0.003). Morphine administration had no effect on hard clinical endpoints (log-rank test p = 0.74) and was not an independent predictor of clinical outcome in Cox regression analysis. In our large multicenter CMR study, morphine administration did not have a negative effect on myocardial damage or clinical prognosis in acute reperfused STEMI. In patients, presenting early ( ≤120 min) morphine may have a cardioprotective effect as reflected by smaller infarcts; but this finding has to be assessed in further well-designed clinical studies Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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15 pages, 1345 KiB  
Article
Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry
by Jun-Won Lee, Jin Sil Moon, Dae Ryong Kang, Sang Jun Lee, Jung-Woo Son, Young Jin Youn, Sung Gyun Ahn, Min-Soo Ahn, Jang-Young Kim, Byung-Su Yoo, Seung-Hwan Lee, Ju Han Kim, Myung Ho Jeong, Jong-Seon Park, Shung Chull Chae, Seung Ho Hur, Myeng-Chan Cho, Seung Woon Rha, Kwang Soo Cha, Jei Keon Chae, Dong-Ju Choi, In Whan Seong, Seok Kyu Oh, Jin Yong Hwang and Junghan Yoonadd Show full author list remove Hide full author list
J. Clin. Med. 2020, 9(2), 505; https://doi.org/10.3390/jcm9020505 - 12 Feb 2020
Cited by 5 | Viewed by 3700
Abstract
Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea [...] Read more.
Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, p < 0.0001) and non-DM (20.4% vs. 6.3%, p < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48–2.10), all-cause death (HR 2.23, 95% CI 1.80–2.76) and any MI (HR 2.34, 95% CI 1.51–3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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14 pages, 1411 KiB  
Article
Impact of Right Atrial Physiology on Heart Failure and Adverse Events after Myocardial Infarction
by Andreas Schuster, Sören J. Backhaus, Thomas Stiermaier, Jenny-Lou Navarra, Johannes Uhlig, Karl-Philipp Rommel, Alexander Koschalka, Johannes T. Kowallick, Boris Bigalke, Shelby Kutty, Matthias Gutberlet, Gerd Hasenfuß, Holger Thiele and Ingo Eitel
J. Clin. Med. 2020, 9(1), 210; https://doi.org/10.3390/jcm9010210 - 12 Jan 2020
Cited by 25 | Viewed by 3224
Abstract
Background: Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in [...] Read more.
Background: Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion need further evaluation. Methods: In this cardiovascular magnetic resonance (CMR)-substudy of AIDA STEMI and TATORT NSTEMI, 1235 AMI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation myocardial infarction and 440 with non-ST-elevation MI). Right atrial (RA) performance was evaluated using CMR myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa), and associated strain rates (SR) in a blinded core-laboratory. The primary endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post AMI. Results: RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with the clinical onset of heart failure and MACE independently of RV systolic function and atrial fibrillation (AF) (multivariable analysis hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.009), while RV systolic function and AF were not independent prognosticators. Furthermore, RA conduit strain identified low- and high-risk groups within patients with reduced RV systolic function (p = 0.019 on log rank testing). Conclusions: RA impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT-derived quantification of RA strain. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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12 pages, 1510 KiB  
Article
High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study
by Nicola Cosentino, Stefano Genovese, Jeness Campodonico, Alice Bonomi, Claudia Lucci, Valentina Milazzo, Marco Moltrasio, Maria Luisa Biondi, Daniela Riggio, Fabrizio Veglia, Roberto Ceriani, Katia Celentano, Monica De Metrio, Mara Rubino, Antonio L. Bartorelli and Giancarlo Marenzi
J. Clin. Med. 2019, 8(12), 2192; https://doi.org/10.3390/jcm8122192 - 12 Dec 2019
Cited by 23 | Viewed by 4146
Abstract
Background. Accumulating evidence suggests that inflammation plays a key role in acute kidney injury (AKI) pathogenesis. We explored the relationship between high-sensitivity C-reactive protein (hs-CRP) and AKI in acute myocardial infarction (AMI). Methods. We prospectively included 2,063 AMI patients in whom hs-CRP was [...] Read more.
Background. Accumulating evidence suggests that inflammation plays a key role in acute kidney injury (AKI) pathogenesis. We explored the relationship between high-sensitivity C-reactive protein (hs-CRP) and AKI in acute myocardial infarction (AMI). Methods. We prospectively included 2,063 AMI patients in whom hs-CRP was measured at admission. AKI incidence and a clinical composite of in-hospital death, cardiogenic shock, and acute pulmonary edema were the study endpoints. Results. Two-hundred-thirty-four (11%) patients developed AKI. hs-CRP levels were higher in AKI patients (45 ± 87 vs. 16 ± 41 mg/L; p < 0.0001). The incidence and severity of AKI, as well as the rate of the composite endpoint, increased in parallel with hs-CRP quartiles (p for trend <0.0001 for all comparisons). A significant correlation was found between hs-CRP and the maximal increase of serum creatinine (R = 0.23; p < 0.0001). The AUC of hs-CRP for AKI prediction was 0.69 (p < 0.001). At reclassification analysis, addition of hs-CRP allowed to properly reclassify 14% of patients when added to creatinine and 8% of patients when added to a clinical model. Conclusions. In AMI, admission hs-CRP is closely associated with AKI development and severity, and with in-hospital outcomes. Future research should focus on whether prophylactic renal strategies in patients with high hs-CRP might prevent AKI and improve outcome. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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11 pages, 588 KiB  
Article
Type 1 or Type 2 Myocardial Infarction in Patients with a History of Coronary Artery Disease: Data from the Emergency Department
by Alain Putot, Mélanie Jeanmichel, Frédéric Chagué, Aurélie Avondo, Patrick Ray, Patrick Manckoundia, Marianne Zeller and Yves Cottin
J. Clin. Med. 2019, 8(12), 2100; https://doi.org/10.3390/jcm8122100 - 2 Dec 2019
Cited by 11 | Viewed by 3053
Abstract
A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our [...] Read more.
A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our study assessed the incidence and characteristics of T2MI compared to type 1 (T1MI) in CAD patients admitted to an ED. Among 33,669 consecutive patients admitted to the ED, 2830 patients with T1MI or T2MI were systematically included after prospective adjudication by the attending clinician according to the universal definition. Among them, 619 (22%) patients had a history of CAD. Using multivariable analysis, CAD history was found to be an independent predictive factor of T2MI versus T1MI (odds ratio (95% confidence interval) = 1.38 (1.08–1.77), p = 0.01). Among CAD patients, those with T2MI (n = 254) were older (median age: 82 vs. 72 years, p < 0.001), and had more frequent comorbidities and more frequent three-vessel disease at the coronary angiography (56% vs. 43%, p = 0.015). Percutaneous coronary intervention was by far less frequent after T2MI than after T1MI (28% vs. 67%, p < 0.001), and in-hospital mortality was twice as high in T2MI (15% vs. 7% for T1MI, p < 0.001). Among biomarkers, the C reactive protein (CRP)/troponin Ic ratio predicted T2MI remarkably well (C-statistic (95% confidence interval) = 0.84 (0.81–0.87, p < 0.001). In a large unselected cohort of MI patients in the ED, a quarter of patients had previous CAD, which was associated with a 40% higher risk of T2MI. CRP/troponin ratios could be used to help distinguish T2MI from T1MI. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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11 pages, 1405 KiB  
Article
Lactate Clearance Predicts Good Neurological Outcomes in Cardiac Arrest Patients Treated with Extracorporeal Cardiopulmonary Resuscitation
by Christian Jung, Sandra Bueter, Bernhard Wernly, Maryna Masyuk, Diyar Saeed, Alexander Albert, Georg Fuernau, Malte Kelm and Ralf Westenfeld
J. Clin. Med. 2019, 8(3), 374; https://doi.org/10.3390/jcm8030374 - 18 Mar 2019
Cited by 28 | Viewed by 3598
Abstract
Background: We evaluated critically ill patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) due to cardiac arrest (CA) with respect to baseline characteristics and laboratory assessments, including lactate and lactate clearance for prognostic relevance. Methods: The primary endpoint was 30-day mortality. The impact on 30-day [...] Read more.
Background: We evaluated critically ill patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) due to cardiac arrest (CA) with respect to baseline characteristics and laboratory assessments, including lactate and lactate clearance for prognostic relevance. Methods: The primary endpoint was 30-day mortality. The impact on 30-day mortality was assessed by uni- and multivariable Cox regression analyses. Neurological outcome assessed by Glasgow Outcome Scale (GOS) was pooled into two groups: scores of 1–3 (bad GOS score) and scores of 4–5 (good GOS score). Results: A total of 93 patients were included in the study. Serum lactate concentration (hazard ratio (HR) 1.09; 95% confidence interval (CI) 1.04–1.13; p < 0.001), hemoglobin, (Hb; HR 0.87; 95% CI 0.79–0.96; p = 0.004), and catecholamine use were associated with 30-day-mortality. In a multivariable model, only lactate clearance (after 6 h; OR 0.97; 95% CI 0.94–0.997; p = 0.03) was associated with a good GOS score. The optimal cut-off of lactate clearance at 6 h for the prediction of a bad GOS score was at ≤13%. Patients with a lactate clearance at 6 h ≤13% evidenced higher rates of bad GOS scores (97% vs. 73%; p = 0.01). Conclusions: Whereas lactate clearance does not predict mortality, it was the sole predictor of good neurological outcomes and might therefore guide clinicians when to stop ECPR. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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Review

Jump to: Research

19 pages, 2248 KiB  
Review
Analyzing Impetus of Regenerative Cellular Therapeutics in Myocardial Infarction
by Ming-Long Chang, Yu-Jui Chiu, Jian-Sing Li, Khoot-Peng Cheah and Hsiu-Hu Lin
J. Clin. Med. 2020, 9(5), 1277; https://doi.org/10.3390/jcm9051277 - 28 Apr 2020
Cited by 4 | Viewed by 4741
Abstract
Both vasculature and myocardium in the heart are excessively damaged following myocardial infarction (MI), hence therapeutic strategies for treating MI hearts should concurrently aim for true cardiac repair by introducing new cardiomyocytes to replace lost or injured ones. Of them, mesenchymal stem cells [...] Read more.
Both vasculature and myocardium in the heart are excessively damaged following myocardial infarction (MI), hence therapeutic strategies for treating MI hearts should concurrently aim for true cardiac repair by introducing new cardiomyocytes to replace lost or injured ones. Of them, mesenchymal stem cells (MSCs) have long been considered a promising candidate for cell-based therapy due to their unspecialized, proliferative differentiation potential to specific cell lineage and, most importantly, their capacity of secreting beneficial paracrine factors which further promote neovascularization, angiogenesis, and cell survival. As a consequence, the differentiated MSCs could multiply and replace the damaged tissues to and turn into tissue- or organ-specific cells with specialized functions. These cells are also known to release potent anti-fibrotic factors including matrix metalloproteinases, which inhibit the proliferation of cardiac fibroblasts, thereby attenuating fibrosis. To achieve the highest possible therapeutic efficacy of stem cells, the other interventions, including hydrogels, electrical stimulations, or platelet-derived biomaterials, have been supplemented, which have resulted in a narrow to broad range of outcomes. Therefore, this article comprehensively analyzed the progress made in stem cells and combinatorial therapies to rescue infarcted myocardium. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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26 pages, 5042 KiB  
Review
Role of Cardiac Magnetic Resonance to Improve Risk Prediction following Acute ST-elevation Myocardial Infarction
by Martin Reindl, Ingo Eitel and Sebastian Johannes Reinstadler
J. Clin. Med. 2020, 9(4), 1041; https://doi.org/10.3390/jcm9041041 - 7 Apr 2020
Cited by 42 | Viewed by 4469
Abstract
Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events [...] Read more.
Cardiac magnetic resonance (CMR) imaging allows comprehensive assessment of myocardial function and tissue characterization in a single examination after acute ST-elevation myocardial infarction. Markers of myocardial infarct severity determined by CMR imaging, especially infarct size and microvascular obstruction, strongly predict recurrent cardiovascular events and mortality. The prognostic information provided by a comprehensive CMR analysis is incremental to conventional risk factors including left ventricular ejection fraction. As such, CMR parameters of myocardial tissue damage are increasingly recognized for optimized risk stratification to further ameliorate the burden of recurrent cardiovascular events in this population. In this review, we provide an overview of the current impact of CMR imaging on optimized risk assessment soon after acute ST-elevation myocardial infarction. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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17 pages, 1218 KiB  
Review
Invasive Evaluation of the Microvasculature in Acute Myocardial Infarction: Coronary Flow Reserve versus the Index of Microcirculatory Resistance
by John-Ross D. Clarke, Randol Kennedy, Freddy Duarte Lau, Gilead I. Lancaster and Stuart W. Zarich
J. Clin. Med. 2020, 9(1), 86; https://doi.org/10.3390/jcm9010086 - 29 Dec 2019
Cited by 9 | Viewed by 8729
Abstract
Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has [...] Read more.
Acute myocardial infarction (AMI) is one of the most common causes of death in both the developed and developing world. It has high associated morbidity despite prompt institution of recommended therapy. The focus over the last few decades in ST-segment elevation AMI has been on timely reperfusion of the epicardial vessel. However, microvascular consequences after reperfusion, such as microvascular obstruction (MVO), are equally reliable predictors of outcome. The attention on the microcirculation has meant that traditional angiographic/anatomic methods are insufficient. We searched PubMed and the Cochrane database for English-language studies published between January 2000 and November 2019 that investigated the use of invasive physiologic tools in AMI. Based on these results, we provide a comprehensive review regarding the role for the invasive evaluation of the microcirculation in AMI, with specific emphasis on coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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19 pages, 3874 KiB  
Review
Microvascular Obstruction in ST-Segment Elevation Myocardial Infarction: Looking Back to Move Forward. Focus on CMR
by Cesar Rios-Navarro, Victor Marcos-Garces, Antoni Bayes-Genis, Oliver Husser, Julio Nuñez and Vicente Bodi
J. Clin. Med. 2019, 8(11), 1805; https://doi.org/10.3390/jcm8111805 - 28 Oct 2019
Cited by 20 | Viewed by 4494
Abstract
After a myocardial infarction (MI), despite the resolution of the coronary occlusion, the deterioration of myocardial perfusion persists in a considerable number of patients. This phenomenon is known as microvascular obstruction (MVO). Initially, the focus was placed on re-establishing blood flow in the [...] Read more.
After a myocardial infarction (MI), despite the resolution of the coronary occlusion, the deterioration of myocardial perfusion persists in a considerable number of patients. This phenomenon is known as microvascular obstruction (MVO). Initially, the focus was placed on re-establishing blood flow in the epicardial artery. Then, the observation that MVO has profound negative structural and prognostic repercussions revived interest in microcirculation. In the near future, the availability of co-adjuvant therapies (beyond timely coronary reperfusion) aimed at preventing, minimizing, and repairing MVOs and finding convincing answers to questions regarding what, when, how, and where to administer these therapies will be of utmost importance. The objective of this work is to review the state-of-the-art concepts on pathophysiology, diagnostic methods, and structural and clinical implications of MVOs in patients with ST-segment elevation MIs. Based on this knowledge we discuss previously-tested and future opportunities for the prevention and repair of MVO. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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Review
Long-Term Risk Factor Control After Myocardial Infarction—A Need for Better Prevention Programmes
by Rico Osteresch, Andreas Fach, Johannes Schmucker, Ingo Eitel, Harald Langer, Rainer Hambrecht and Harm Wienbergen
J. Clin. Med. 2019, 8(8), 1114; https://doi.org/10.3390/jcm8081114 - 27 Jul 2019
Cited by 7 | Viewed by 3205
Abstract
Introduction: Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock. To improve long-term prognosis and prevent recurrent events, sustainable cardiovascular risk factor control (RFC) after MI is crucial. Methods: The article gives an overview on [...] Read more.
Introduction: Long-term prognosis of myocardial infarction (MI) is still serious, especially in patients with MI and cardiogenic shock. To improve long-term prognosis and prevent recurrent events, sustainable cardiovascular risk factor control (RFC) after MI is crucial. Methods: The article gives an overview on health care data regarding RFC after MI and presents recent trials on modern preventive strategies that support patients to achieve risk factor targets during long-term course. Results: International registry studies, such as EUROASPIRE, observed alarming deficiencies in RFC after MI. As data of the German Bremen ST-segment elevation myocardial infarction (STEMI)-Registry show, most deficiencies are found in socially disadvantaged city districts and in young patients. Several studies on prevention programmes to improve RFC after MI reported inconsistent data; however, in the recently published IPP trial a 12-months intensive prevention programme that included both repetitive personal contacts with non-physician prevention assistants and telemetric risk factor control, was associated with significant improvements of numerous risk factors (smoking, LDL and total cholesterol, systolic blood pressure and physical inactivity). Conclusions: There is a strong need of action to improve long-term risk RFC after MI, especially in socially disadvantaged patients. Modern prevention programmes, using personal and telemetric contacts, have large potential to support patients in achieving long-term risk factor targets after coronary events. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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10 pages, 268 KiB  
Review
Daylight Saving Time and Acute Myocardial Infarction: A Meta-Analysis
by Roberto Manfredini, Fabio Fabbian, Rosaria Cappadona, Alfredo De Giorgi, Francesca Bravi, Tiziano Carradori, Maria Elena Flacco and Lamberto Manzoli
J. Clin. Med. 2019, 8(3), 404; https://doi.org/10.3390/jcm8030404 - 23 Mar 2019
Cited by 42 | Viewed by 29317
Abstract
Background: The available evidence on the effects of daylight saving time (DST) transitions on major cardiovascular diseases is limited and conflicting. We carried out the first meta-analysis aimed at evaluating the risk of acute myocardial infarction (AMI) following DST transitions. Methods: We searched [...] Read more.
Background: The available evidence on the effects of daylight saving time (DST) transitions on major cardiovascular diseases is limited and conflicting. We carried out the first meta-analysis aimed at evaluating the risk of acute myocardial infarction (AMI) following DST transitions. Methods: We searched cohort or case-control studies evaluating the incidence of AMI, among adults (≥18 y), during the weeks following spring and/or autumn DST shifts, versus control periods. The search was made in MedLine and Scopus, up to 31 December 2018, with no language restriction. A summary odds ratio of AMI was computed after: (1) spring, (2) autumn or (3) both transitions considered together. Meta-analyses were also stratified by gender and age. Data were combined using a generic inverse-variance approach. Results: Seven studies (>115,000 subjects) were included in the analyses. A significantly higher risk of AMI (Odds Ratio: 1.03; 95% CI: 1.01–1.06) was observed during the two weeks following spring or autumn DST transitions. However, although AMI risk increased significantly after the spring shift (OR: 1.05; 1.02–1.07), the incidence of AMI during the week after winter DST transition was comparable with control periods (OR 1.01; 0.98–1.04). No substantial differences were observed when the analyses were stratified by age or gender. Conclusion: The risk of AMI increases modestly but significantly after DST transitions, supporting the proposal of DST shifts discontinuation. Additional studies that fully adjust for potential confounders are required to confirm the present findings. Full article
(This article belongs to the Special Issue Therapies for Myocardial Injury and Infarction)
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