Universal Definition of Myocardial Infarction

Thygesen, Kristian; Alpert, Joseph S.; White, Harvey D.

doi:10.1016/j.jacc.2007.09.011

Cited by 1,480 publications

(519 citation statements)

References 89 publications

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“…Thus, we modified case‐control definitions for exploratory sensitivity analyses: Inclusion criteria for the first set of sensitivity cohorts retained all specifications described above, but also required presence or absence of objective HF indicators (elevated n‐terminal prohormone of brain natriuretic peptide >400 pg/mL, loop diuretic use, or HF International Classification of Diseases, Ninth Revision code) and excluded all patients with major adverse cardiac events (defined as myocardial infarction consistent with the universal definition,26 percutaneous coronary intervention, or coronary artery bypass grafting) 1 month before sample collection. Inclusion criteria for the second set of sensitivity cohorts varied only in its LVEF thresholds: HFpEF and no‐HF groups had LVEF ≥50% and HFrEF had LVEF <35%.…”

Section: Methodsmentioning

confidence: 99%

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Hunter

Kelly

McGarrah

et al. 2016

JAHA

201

137

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BackgroundMetabolic impairment is an important contributor to heart failure (HF) pathogenesis and progression. Dysregulated metabolic pathways remain poorly characterized in patients with HF and preserved ejection fraction (HFpEF). We sought to determine metabolic abnormalities in HFpEF and identify pathways differentially altered in HFpEF versus HF with reduced ejection fraction (HFrEF).Methods and ResultsWe identified HFpEF cases, HFrEF controls, and no‐HF controls from the CATHGEN study of sequential patients undergoing cardiac catheterization. HFpEF cases (N=282) were defined by left ventricular ejection fraction (LVEF) ≥45%, diastolic dysfunction grade ≥1, and history of HF; HFrEF controls (N=279) were defined similarly, except for having LVEF <45%. No‐HF controls (N=191) had LVEF ≥45%, normal diastolic function, and no HF diagnosis. Targeted mass spectrometry and enzymatic assays were used to quantify 63 metabolites in fasting plasma. Principal components analysis reduced the 63 metabolites to uncorrelated factors, which were compared across groups using ANCOVA. In basic and fully adjusted models, long‐chain acylcarnitine factor levels differed significantly across groups (P<0.0001) and were greater in HFrEF than HFpEF (P=0.0004), both of which were greater than no‐HF controls. We confirmed these findings in sensitivity analyses using stricter inclusion criteria, alternative LVEF thresholds, and adjustment for insulin resistance.ConclusionsWe identified novel circulating metabolites reflecting impaired or dysregulated fatty acid oxidation that are independently associated with HF and differentially elevated in HFpEF and HFrEF. These results elucidate a specific metabolic pathway in HF and suggest a shared metabolic mechanism in HF along the LVEF spectrum.

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Section: Methodsmentioning

confidence: 99%

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Hunter

Kelly

McGarrah

et al. 2016

JAHA

201

137

View full text Add to dashboard Cite

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“…Platelet inhibition or percent change in result PRU from baseline (calculated as [1−(result PRU)/(base PRU)]×100%)16 was also reported as available. MACE included periprocedural MI (<24 hours after PCI: creatine kinase–myocardial band elevation at least 3‐fold greater than the 99% upper limit of normal with normal baseline, or >20% rise from stable elevated baseline),17 nonperiprocedural MI (>24 hours after PCI) with or without concurrent ST‐segment elevation, rehospitalization for a suspected ACS, unplanned repeat revascularization, definite stent thrombosis, transient ischemic attack, ischemic or hemorrhagic stroke, or any death.…”

Section: Methodsmentioning

confidence: 99%

Elevated Baseline Serum Fibrinogen: Effect on 2‐Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Ang

Behnamfar

Palakodeti

et al. 2017

JAHA

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BackgroundElevated fibrinogen is associated with short‐term major adverse cardiovascular events (MACE) after percutaneous coronary intervention, but the relation with late MACE is unknown.Methods and ResultsBaseline demographics and 2‐year MACE were recorded among subjects undergoing nonemergent percutaneous coronary intervention. A total of 332 subjects (66.6±19.5 years, 69.9% male, 25.3% acute coronary syndrome) were enrolled. Two‐year MACE (periprocedural myocardial infarction 9.0%, rehospitalization 6.3%, revascularization 12.7%, non–periprocedural myocardial infarction 4.5%, stent thrombosis 0.9%, stroke 1.8%, and death 0.6%) were associated with higher fibrinogen (352.8±123.4 mg/dL versus 301.6±110.8 mg/dL; P<0.001), longer total stent length (40.1±25.3 mm versus 32.1±19.3 mm; P=0.004), acute coronary syndrome indication (38.7% versus 17.8%; P<0.001), number of bare‐metal stents (0.5±1.1 versus 0.2±0.5; P=0.002), and stent diameter ≤2.5 mm (55.8% versus 38.4%, P=0.003). No relation between platelet reactivity and 2‐year MACE was observed. Fibrinogen ≥280 mg/dL (odds ratio [OR] 3.0, confidence interval [CI], 1.6–5.4, P<0.001), total stent length ≥32 mm (OR 2.2, CI, 1.3–3.8, P<0.001), acute coronary syndrome indication (OR 4.1, CI, 2.3–7.5, P<0.001), any bare‐metal stents (OR 3.2, CI, 1.6–6.1, P<0.001), and stent diameter ≤2.5 mm (OR 2.0, CI, 1.2–3.5, P=0.010) were independently associated with 2‐year MACE. Following a landmark analysis excluding periprocedural myocardial infarction, fibrinogen ≥280 mg/dL remained strongly associated with 2‐year MACE (37.0% versus 17.4%, log‐rank P<0.001).ConclusionsElevated baseline fibrinogen level is associated with 2‐year MACE after percutaneous coronary intervention. Acute coronary syndrome indication for percutaneous coronary intervention, total stent length implanted, and use of bare‐metal stents or smaller‐diameter stents are also independently associated with 2‐year MACE, while measures of on‐thienopyridine platelet reactivity are not.

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“…Medical records were reviewed by a physician‐led team, and events were adjudicated following established guidelines 34, 35. Specifically, medical records were examined for signs or symptoms of ischemia, a rising and/or falling pattern in cardiac troponin or creatinine phosphokinase‐MB over ≥6 hours with a peak value greater than or equal to twice the upper limit of normal (diagnostic cardiac enzymes), and ECG changes consistent with ischemia or myocardial infarction.…”

Section: Methodsmentioning

confidence: 99%

“…Proxies or next of kin were interviewed to obtain information about the circumstances of the death. Proxy interviews, medical history, medical records in the final year of life, death certificates, and autopsy reports were gathered and reviewed by physician‐led adjudicators to determine whether the death was caused by CVD 34, 35…”

Section: Methodsmentioning

confidence: 99%

Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low‐ and High‐Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

Sumner

Khodneva

Muntner

et al. 2016

JAHA

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BackgroundPsychosocial risk for cardiovascular disease (CVD) may be especially deleterious in persons with low socioeconomic status. Most work has focused on psychosocial factors individually, but emerging research suggests that the confluence of psychosocial risk may be particularly harmful. Using data from the Reasons for Geographical and Racial Differences in Stroke (REGARDS) study, we examined associations among depressive symptoms and stress, alone and in combination, and incident CVD and all‐cause mortality as a function of socioeconomic status.Methods and ResultsAt baseline, 22 658 participants without a history of CVD (58.8% female, 41.7% black, mean age 63.9±9.3 years) reported on depressive symptoms, stress, annual household income, and education. Participants were classified into 1 of 3 psychosocial risk groups at baseline: (1) neither depressive symptoms nor stress, (2) either depressive symptoms or stress, or (3) both depressive symptoms and stress. Cox proportional hazards models were used to predict physician‐adjudicated incident total CVD events (nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) and all‐cause mortality over a median of 7.0 years (interquartile range 5.4–8.3 years) of follow‐up. In fully adjusted models, participants with both depressive symptoms and stress had the greatest elevation in risk of developing total CVD (hazard ratio 1.48, 95% CI 1.21–1.81) and all‐cause mortality (hazard ratio 1.33, 95% CI 1.13–1.56) but only for those with low income (<$35 000) and not high (≥$35 000) income. This pattern of results was not observed in models stratified by education.ConclusionsFindings suggest that screening for a combination of elevated depressive symptoms and stress in low‐income persons may help identify those at increased risk of incident CVD and mortality.

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Universal Definition of Myocardial Infarction

Cited by 1,480 publications

References 89 publications

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Metabolomic Profiling Identifies Novel Circulating Biomarkers of Mitochondrial Dysfunction Differentially Elevated in Heart Failure With Preserved Versus Reduced Ejection Fraction: Evidence for Shared Metabolic Impairments in Clinical Heart Failure

Elevated Baseline Serum Fibrinogen: Effect on 2‐Year Major Adverse Cardiovascular Events Following Percutaneous Coronary Intervention

Effects of Concurrent Depressive Symptoms and Perceived Stress on Cardiovascular Risk in Low‐ and High‐Income Participants: Findings From the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study

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