Alpert JS, Thygesen K, Antman E, Bassand JP. Myocardial infarction redefined: a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction
Definition of MI. Criteria for acute, evolving or recent MI. Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI: 1) Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following: a) ischemic symptoms; b) development of pathologic Qwaves on the ECG; c) ECG changes indicative of ischemia (ST segment elevation or depression); or d) coronary artery intervention (e.g., coronary angioplasty). 2) Pathologic findings of an acute MI. Criteria for established MI. Any one of the following criteria satisfies the diagnosis for established MI: 1) Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed. 2) Pathologic findings of a healed or healing MI.
"Cardiac muscle expresses the troponin T and I isoforms, so cardiac troponin T (cTnT) and I (cTnI) are more specific than creatine kinase (CK) values for myocardial injury and, owing to their high sensitivity, may rise when creatine kinase MB (CK-MB) concentrations do not . Many contributors may raise cardiac enzyme levels after cardiac surgery, such as acute coronary syndrome (ACS) related to recent myocardial infarction (AMI) before the surgery , or directly related to cardiac surgery in perioperative myocardial infarction (PMI), such as inadequate cardiac protection, reperfusion injury, and direct surgical trauma . Such elevations during cardiac surgery may not be ACS-related, as these enzymes may be already elevated in patients with end-stage renal disease , acute pericarditis, acute heart failure (AHF) , sepsis , or rhabdomyolysis . "
[Show abstract][Hide abstract] ABSTRACT: Perioperative myocardial infarction (PMI) confers a considerable risk in cardiac surgery settings; finding the ideal biomarker seems to be an ideal goal. Our aim was to assess the diagnostic accuracy of highly sensitive troponin T (hsTnT) in cardiac surgery settings and to define a diagnostic level for PMI diagnosis. This was a single-center prospective observational study analyzing data from all patients who underwent cardiac surgeries. The primary outcome was the diagnosis of PMI through a specific level. The secondary outcome measures were the lengths of mechanical ventilation (LOV), stay in the intensive care unit (LOSICU), and hospitalization. Based on the third universal definition of PMI, patients were divided into two groups: no PMI (Group I) and PMI (Group II). Data from 413 patients were analyzed. Nine patients fulfilled the diagnostic criteria of PMI, while 41 patients were identified with a 5-fold increase in their CK-MB (≥120 U/L). Using ROC analysis, a hsTnT level of 3,466 ng/L or above showed 90% sensitivity and 90% specificity for the diagnosis of PMI. Secondary outcome measures in patients with PMI were significantly prolonged. In conclusion, the hsTnT levels detected here paralleled those of CK-MB and a cut-off level of 3466 ng/L could be diagnostic of PMI.
BioMed Research International 11/2015; 2015(891707). DOI:10.1155/2015/891707" · 3.17 Impact Factor
"A patient is diagnosed with acute myocardial infarction if a typical rise and gradual fall (troponin) or a more rapid rise and fall (creatine kinase-MB, CK-MB) of biochemical markers of myocardial necrosis are seen with at least one of the following: (a) ischemic symptoms; (b) development of pathologic Q waves on the electrocardiogram (ECG); or (c) ECG changes indicative of ischemia (ST segment elevation or depression) . When myocardial necrosis occurs, troponin rises before CK/CK-MB. "
[Show abstract][Hide abstract] ABSTRACT: . Acute myocardial infarction is life-threatening. A cardiac troponin rise accompanied by typical symptoms, ST elevation or depression is diagnostic of acute myocardial infarction. Here, we report an unusual case of a female who was admitted with chest pain. However, she did not present with a typical profile of an acute myocardial infarction patient.
. A 66-year-old Han nationality female presented with chest pain. The electrocardiogram (ECG) revealed arched ST segment elevations and troponin was elevated. However, the coronary angiography showed a normal coronary arterial system. Thyroid function tests showed that this patient had severe hyperthyroidism.
. Our case highlights the possibility that hyperthyroidism may cause a large area of myocardium injury and ECG ST segment elevation. We suggest routine thyroid function testing in patients with chest pain.
"CTns are used in conjunction with other investigations, such as electrocardiogram (ECG) changes, allowing, for example, to determine whether a patient has had a " STEMI " type MI (with ST segment Elevation by ECG). ECG cannot pick up non-STEMI cases and here laboratory biomarkers are highly important (Alpert et al., 2000 "
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