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Diagnosis, Monitoring, and Treatment of Myocardial Infarction

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

Deadline for manuscript submissions: closed (20 April 2025) | Viewed by 26302

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Dr. Elad Asher

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Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103102, Israel
Interests: ACS; cardiogenic shock; interventional cardiology
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Special Issue Information

Dear Colleagues,

This Special Issue of the Journal of Clinical Medicine will highlight the latest findings in the diagnosis, monitoring, and treatment of patients with acute myocardial infarction (MI). This involves the evaluation of biomarkers, lipids, ECGs, risk scoring systems, cardiovascular genetics, monitoring, non-invasive and invasive cardiovascular testing, invasive treatment, and prognosis. Moreover, special focus on artificial intelligence and gender are welcome.

This Special Issue aims to provide researchers with an opportunity to publish both original research and review articles related to recent advances in the acute MI field, with a particular focus on the diagnosis, monitoring, and treatment of acute MI, which is still one of the leading causes of death in the modern world.

Dr. Elad Asher
Guest Editor

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Keywords

diagnosis
acute MI
monitoring
treatment

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Published Papers (7 papers)

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Research

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12 pages, 1037 KiB

Open AccessArticle

Elevated miRNA-499 Levels in Early Phase of Non-ST Elevation Acute Coronary Syndromes Predict Increased Long-Term Risk of Major Adverse Cardiac Events

by Dawid Miśkowiec, Ewa Szymczyk, Paulina Wejner-Mik, Błażej Michalski, Piotr Lipiec, Michał Simiera, Karolina Kupczyńska and Jarosław D. Kasprzak

J. Clin. Med. 2024, 13(24), 7803; https://doi.org/10.3390/jcm13247803 - 20 Dec 2024

Viewed by 783

Abstract

Background/Objectives: Available data suggest the diagnostic potential of testing microRNAs (miRs) in myocardial infarction, but their prognostic value remains unclear. To evaluate the prognostic value of circulating miRs (miR-1, miR-21, miR-133a, miR-208 and miR-499) for predicting major adverse cardiac events (MACEs), including death, non-fatal myocardial infarction (MI) or cardiovascular rehospitalization, in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS). Methods: Our prospective, single-center, observational study included patients (pts) with NSTE-ACS admitted <24 h after symptoms onset and pts with confirmed stable coronary artery disease (SCAD) as controls. Relative expression of miRs was calculated, and subjects were categorized according to miRs expression on hospital admission into two groups (≤median and >median). Results: Overall, 103 NSTE-ACS (52 NSTEMI/51 UA) and 47 SCAD pts (median age 66 years, 67% male) were included. During the median 895 (581–1134) days of the follow-up, MACE occurred in 75 (50%) patients: 20 (13%) died, 28 (19%) presented with MI, and 65 (43%) were readmitted due to cardiovascular reasons. Incidence of MI, rehospitalization and MACE was significantly higher in pts with elevated (>median) miR-499 [MI: 34.3% vs. 7.3%; HR = 6.0 (2.8–12.7) for rehospitalization; 53.7% vs. 36.2%, HR = 2.3 (1.4–3.8) for MACE; 62.7% vs. 42%, HR = 2.4 (1.5–3.8)] for hospital readmission. In the Cox proportional hazards regression model, miR-499 expression above the median level [HR = 1.8 (1.1–3.1)], high-sensitivity cardiac troponin T [HR = 1.2 (1.02–1.5)], diabetes [HR = 1.7 (1.1–2.8)] and percutaneous intervention during hospital stay [HR = 2.1 (1.1–3.8)] were identified as independent predictors of MACE in long-term observation, even after adjustment for covariates. Conclusions: Elevated miR-499 level on hospital admission in NSTE-ACS is related to an increased rate of MACE in the 2.5-year follow-up. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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13 pages, 451 KiB

Open AccessArticle

Echocardiographic Predictors of Improvement of Left Ventricular Ejection Fraction below 35% in Patients with ST-Segment Elevation Myocardial Infarction

by Hezzy Shmueli, Gal Tsaban, Anna Moreno, David Shamia, Itai Weissberg, David Uziel, Artyom Star, Khaled Elhaj and Yigal Abramowitz

J. Clin. Med. 2024, 13(14), 4016; https://doi.org/10.3390/jcm13144016 - 9 Jul 2024

Viewed by 1187

Abstract

Introduction: An ST-elevation myocardial infarction (STEMI) is a clinical syndrome defined by symptoms of myocardial ischemia, persistent electrocardiographic ST-segment elevation and subsequent release of biomarkers suggestive of myocardial necrosis. In clinical practice, echocardiography has become essential in evaluating patients after acute myocardial infarction. We aimed to assess clinical and echocardiographic parameters that may affect LV function recovery in patients after STEMI. Methods: This study is a retrospective observational study from a tertiary referral center in Israel. We collected patients that were admitted with STEMI and a left ventricular ejection fraction (LVEF) below 35% on preliminary echocardiography at the index hospitalization and compared the findings to a follow-up study performed within 1–6 months after that event, in order to see if there are predictors of LVEF change > 10% within 90 days following STEMI. Results: This study included 101 patients that were admitted between 2016 and 2021. Within a median follow-up of 9.7 weeks (IQR 5.9–17.1), 27 (25.2%) patients had improved their LVEF, and 74 (69.2%) had no change or further reduced LVEF. Compared to patients without LVEF improvement, those with improved LVEF were more likely to be female (29.6% vs. 9.5%, p = 0.01), less likely to suffer from hypertension (33.3% vs. 56.8%, p = 0.04) and had marginally higher rates of thrombolysis treatment (14.1% vs. 4.1%, p = 0.06). Conclusions: in the population of STEMI patients with residual LVEF < 35%, approximately a quarter will improve at least 10% in their follow-up LVEF, and there were no clear echocardiographic predictors for this improvement. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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13 pages, 1390 KiB

Open AccessArticle

Prevalence and Impact of Concomitant Atrial Fibrillation in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction

by Iqra Shakeel, Harish Sharma, James Hodson, Hamna Iqbal, Rashna Tashfeen, Peter F. Ludman, Richard P. Steeds, Jonathan N. Townend, Sagar N. Doshi and M. Adnan Nadir

J. Clin. Med. 2024, 13(8), 2318; https://doi.org/10.3390/jcm13082318 - 17 Apr 2024

Cited by 2 | Viewed by 1228

Abstract

Background: Concomitant atrial fibrillation (AF) is associated with an adverse prognosis in patients with acute myocardial infarction (MI). However, it remains unclear whether this is due to a causal effect of AF or whether AF acts as a surrogate marker for comorbidities in this population. Furthermore, there are limited data on whether coronary artery disease distribution impacts the risk of developing AF. Methods: Consecutive patients admitted with acute MI and treated using percutaneous coronary intervention (PCI) at a single centre were retrospectively identified. Associations between AF and major adverse cardiac and cerebrovascular events (MACCEs) over a median of five years of follow-up were assessed using Cox regression, with adjustment for confounding factors performed using both multivariable modelling and a propensity-score-matched analysis. Results: AF was identified in N = 65/1000 (6.5%) of cases; these patients were significantly older (mean: 73 vs. 65 years, p < 0.001), with lower creatinine clearance (p < 0.001), and were more likely to have a history of cerebrovascular disease (p = 0.011) than those without AF. In addition, patients with AF had a greater propensity for left main stem (p = 0.001) or left circumflex artery (p = 0.004) involvement. Long-term MACCE rates were significantly higher in the AF group than in the non-AF group (50.8% vs. 34.2% at five years), yielding an unadjusted hazard ratio (HR) of 1.86 (95% CI: 1.32–2.64, p < 0.001). However, after adjustment for confounding factors, AF was no longer independently associated with MACCEs, either on multivariable (adjusted HR: 1.25, 95% CI: 0.81–1.92, p = 0.319) or propensity-score-matched (HR: 1.04, 95% CI: 0.59–1.82, p = 0.886) analyses. Conclusions: AF is observed in 6.5% of patients admitted with acute MI, and those with AF are more likely to have significant diseases involving left main or circumflex arteries. Although unadjusted MACCE rates were significantly higher in patients with AF, this effect was not found to remain significant after adjustment for comorbidities. As such, this study provided no evidence to suggest that AF is independently associated with MACCEs. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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16 pages, 2621 KiB

Open AccessArticle

Short-Course High-Intensity Statin Treatment during Admission for Myocardial Infarction and LDL-Cholesterol Reduction—Impact on Tailored Lipid-Lowering Therapy at Discharge

by Víctor Marcos-Garcés, Héctor Merenciano-González, María Luz Martínez Mas, Patricia Palau, Josefa Inés Climent Alberola, Nerea Perez, Laura López-Bueno, María Concepción Esteban Argente, María Valls Reig, Raquel Muñoz Alcover, Inmaculada Pradillas Contreras, Ana Arizón Benito, Alfonso Payá Rubio, César Ríos-Navarro, Elena de Dios, Jose Gavara, Francisco Javier Chorro, Juan Sanchis and Vicente Bodi

J. Clin. Med. 2024, 13(1), 127; https://doi.org/10.3390/jcm13010127 - 25 Dec 2023

Cited by 3 | Viewed by 2347

Abstract

We hypothesized that a short-course high-intensity statin treatment during admission for myocardial infarction (MI) could rapidly reduce LDL-C and thus impact the choice of lipid-lowering therapy (LLT) at discharge. Our cohort comprised 133 MI patients (62.71 ± 11.3 years, 82% male) treated with atorvastatin 80 mg o.d. during admission. Basal LDL-C levels before admission were analyzed. We compared lipid profile variables before and during admission, and LLT at discharge was registered. Achieved theoretical LDL-C levels were estimated using LDL-C during admission and basal LDL-C as references and compared to LDL-C on first blood sample 4–6 weeks after discharge. A significant reduction in cholesterol from basal levels was noted during admission, including total cholesterol, triglycerides, HDL-C, non-HDL-C, and LDL-C (−39.23 ± 34.89 mg/dL, p < 0.001). LDL-C levels were reduced by 30% in days 1–2 and 40–45% in subsequent days (R² 0.766, p < 0.001). Using LDL-C during admission as a reference, most patients (88.7%) would theoretically achieve an LDL-C < 55 mg/dL with discharge LLT. However, if basal LDL-C levels were considered as a reference, only a small proportion of patients (30.1%) would achieve this lipid target, aligned with the proportion of patients with LDL-C < 55 mg/dL 4–6 weeks after discharge (36.8%). We conclude that statin treatment during admission for MI can induce a significant reduction in LDL-C and LLT at discharge is usually prescribed using LDL-C during admission as the reference, which leads to insufficient LDL-C reduction after discharge. Basal LDL-C before admission should be considered as the reference value for tailored LLT prescription. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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11 pages, 268 KiB

Open AccessArticle

Safety and Outcomes of Peripherally Administered Vasopressor Infusion in Patients Admitted with Shock to an Intensive Cardiac Care Unit—A Single-Center Prospective Study

by Elad Asher, Hani Karameh, Hamed Nassar, Chaim Yosefy, David Marmor, Nimrod Perel, Louay Taha, Meir Tabi, Omri Braver, Mony Shuvy, Yonit Wiener-Well, Michael Glikson and Sharon Bruoha

J. Clin. Med. 2023, 12(17), 5734; https://doi.org/10.3390/jcm12175734 - 3 Sep 2023

Cited by 6 | Viewed by 3266

Abstract

Background: Vasopressors are frequently utilized for blood pressure stabilization in patients with cardiogenic shock (CS), although with a questionable benefit. Obtaining central venous access is time consuming and may be associated with serious complications. Hence, we thought to evaluate whether the administration of vasopressors through a peripheral venous catheter (PVC) is a safe and effective alternative for the management of patients with CS presenting to the intensive cardiovascular care unit (ICCU). Methods: A prospective single-center study was conducted to compare the safety and outcomes of vasopressors administered via a PVC vs. a central venous catheter (CVC) in patients presenting with CS over a 12-month period. Results: A total of 1100 patients were included; of them, 139 (12.6%) required a vasopressor treatment due to shock, with 108 (78%) treated via a PVC and 31 (22%) treated via a CVC according to the discretion of the treating physician. The duration of the vasopressor administration was shorter in the PVC group compared with the CVC group (2.5 days vs. 4.2 days, respectively, p < 0.05). Phlebitis and the extravasation of vasopressors occurred at similar rates in the PVC and CVC groups (5.7% vs. 3.3%, respectively, p = 0.33; 0.9% vs. 3.3%, respectively, p = 0.17). Nevertheless, the bleeding rate was higher in the CVC group compared with the PVC group (3% vs. 0%, p = 0.03). Conclusions: The administration of vasopressor infusions via PVC for the management of patients with CS is feasible and safe in patients with cardiogenic shock. Further studies are needed to establish this method of treatment. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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11 pages, 1259 KiB

Open AccessArticle

Sex Differences in the Diagnosis, Management, and Outcomes of Suspected Non-ST-Elevation Acute Coronary Syndromes Meeting Rapid Rule-Out Criteria

by Ben Cohen, Ruth Tor, Alon Grossman, Ran Kornowski, Avital Porter and David Hasdai

J. Clin. Med. 2023, 12(17), 5704; https://doi.org/10.3390/jcm12175704 - 1 Sep 2023

Viewed by 1514

Abstract

(1) Background: patients who meet current rapid rule-out criteria for myocardial infarction (MI) are considered low risk, yet their management remains nebulous, especially among women. We aimed to examine sex differences in the diagnosis, management, and outcomes of patients meeting the rapid rule-out criteria. (2) Methods: by simulating application of the rapid rule-out MI criteria, we analyzed consecutively triaged men and women with suspected NSTE-ACS who had high-sensitivity cardiac troponin T (hs-cTnT) values that met criteria (n = 11,477), in particular, those who were admitted (n = 3775). (3) Results: men constituted ~55% of triaged patients who met the rule-out criteria, whether admitted or discharged. Men were more likely to be admitted (33.7% vs. 31.9%, p = 0.04), more commonly with hs-cTnT values between level of detection (LOD, 5 ng/ml) and the 99th percentile (59.4% of all admissions vs. 40.5% for women), whereas women were more likely to be admitted with values < level of blank (LOB, 3 ng/mL; 22.9% vs. 9.2% for men). Thirty-day mortality (1 man and 1 woman) and in-hospital MI (9 men vs. 1 woman) were uncommon among admitted patients, yet resource utilization during 3–4 hospitalization days was substantial for both sexes, with men undergoing coronary angiography (6.8% vs. 2.9%) and revascularization (3.4% vs. 1.1%) more commonly. Long-term survival for both men and women, whether admitted or discharged, was significantly worse for hs-cTnT values between LOD and the 99th percentile, even after adjusting for age and cardiovascular comorbidities. (4) Conclusions: reporting actual hs-cTnT values < 99th percentile allows for better risk stratification, especially for women, possibly closing the sex gap. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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Review

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19 pages, 1334 KiB

Open AccessFeature PaperReview

Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence

by Stefano Cacciatore, Luigi Spadafora, Marco Bernardi, Mattia Galli, Matteo Betti, Francesco Perone, Giulia Nicolaio, Emanuele Marzetti, Anna Maria Martone, Francesco Landi, Elad Asher, Maciej Banach, Olivier Hanon, Giuseppe Biondi-Zoccai and Pierre Sabouret

J. Clin. Med. 2023, 12(16), 5233; https://doi.org/10.3390/jcm12165233 - 11 Aug 2023

Cited by 40 | Viewed by 15050

Abstract

Coronary artery disease (CAD) is highly prevalent in older adults, yet its management remains challenging. Treatment choices are made complex by the frailty burden of older patients, a high prevalence of comorbidities and body composition abnormalities (e.g., sarcopenia), the complexity of coronary anatomy, and the frequent presence of multivessel disease, as well as the coexistence of major ischemic and bleeding risk factors. Recent randomized clinical trials and epidemiological studies have provided new data on optimal management of complex patients with CAD. However, frail older adults are still underrepresented in the literature. This narrative review aims to highlight the importance of assessing frailty as an aid to guide therapeutic decision-making and tailor CAD management to the specific needs of older adults, taking into account age-related pharmacokinetic and pharmacodynamic changes, polypharmacy, and potential drug interactions. We also discuss gaps in the evidence and offer perspectives on how best in the future to optimize the global strategy of CAD management in older adults. Full article

(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Myocardial Infarction)

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