Clinical classification of acute myocardial infarction: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 64: Line 64:


Five types of MI are now recognized and classified as follows: <ref name="pmid17951284">{{cite journal |author=Thygesen K, Alpert JS, White HD, ''et al'' |title=Universal definition of myocardial infarction |journal=Circulation |volume=116 |issue=22 |pages=2634–53 |year=2007 |month=November |pmid=17951284 |doi=10.1161/CIRCULATIONAHA.107.187397 |url=}}</ref>
Five types of MI are now recognized and classified as follows: <ref name="pmid17951284">{{cite journal |author=Thygesen K, Alpert JS, White HD, ''et al'' |title=Universal definition of myocardial infarction |journal=Circulation |volume=116 |issue=22 |pages=2634–53 |year=2007 |month=November |pmid=17951284 |doi=10.1161/CIRCULATIONAHA.107.187397 |url=}}</ref>
'''Type 1:''' '''Spontaneous''' myocardial infarction related to [[ischemia]] due to a primary coronary event, such as plaque erosion and/or rupture, fissuring, or dissection.
'''Type 1:''' '''Spontaneous''' myocardial infarction related to [[ischemia]] due to a primary coronary event, such as plaque erosion and/or rupture, fissuring, or dissection.
'''Type 2:''' Myocardial infarction secondary to [[ischemia]] due to an '''imbalance of O<sub>2</sub> supply and demand''', as from coronary spasm or [[embolism]], [[anemia]], [[arrhythmias]], [[hypertension]], or [[hypotension]]
'''Type 2:''' Myocardial infarction secondary to [[ischemia]] due to an '''imbalance of O<sub>2</sub> supply and demand''', as from coronary spasm or [[embolism]], [[anemia]], [[arrhythmias]], [[hypertension]], or [[hypotension]]
'''Type 3:''' '''[[Sudden cardiac death|Sudden unexpected cardiac death]]''', including [[cardiac arrest]], often with symptoms suggesting [[ischemia]] with new [[STEMI|ST segment elevation]]; new [[left bundle branch block]]; or pathologic or angiographic evidence of fresh [[thrombus|coronary thrombus]] (in the absence of reliable biomarker findings)
'''Type 3:''' '''[[Sudden cardiac death|Sudden unexpected cardiac death]]''', including [[cardiac arrest]], often with symptoms suggesting [[ischemia]] with new [[STEMI|ST segment elevation]]; new [[left bundle branch block]]; or pathologic or angiographic evidence of fresh [[thrombus|coronary thrombus]] (in the absence of reliable biomarker findings)
'''Type 4:'''
'''Type 4:'''
:a. Myocardial infarction associated with '''[[PCI|Percutaneous Coronary Interventions]]''' ([[PCI]])
:a. Myocardial infarction associated with '''[[PCI|Percutaneous Coronary Interventions]]''' ([[PCI]])
:b. Myocardial infarction associated with documented '''[[stent thrombosis]]'''.
:b. Myocardial infarction associated with documented '''[[stent thrombosis]]'''.
'''Type 5:''' Myocardial infarction associated with '''[[Cardiac surgery|Coronary Artery Bypass Graft surgery]]
'''Type 5:''' Myocardial infarction associated with '''[[Cardiac surgery|Coronary Artery Bypass Graft surgery]]
'''
'''

Revision as of 00:20, 29 April 2009

Myocardial infarction
Acute Myocardial infarction; Posterior wall.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology
ICD-10 I21-I22
ICD-9 410
DiseasesDB 8664
MedlinePlus 000195
eMedicine med/1567  emerg/327 ped/2520

WikiDoc Resources for Clinical classification of acute myocardial infarction

Articles

Most recent articles on Clinical classification of acute myocardial infarction

Most cited articles on Clinical classification of acute myocardial infarction

Review articles on Clinical classification of acute myocardial infarction

Articles on Clinical classification of acute myocardial infarction in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Clinical classification of acute myocardial infarction

Images of Clinical classification of acute myocardial infarction

Photos of Clinical classification of acute myocardial infarction

Podcasts & MP3s on Clinical classification of acute myocardial infarction

Videos on Clinical classification of acute myocardial infarction

Evidence Based Medicine

Cochrane Collaboration on Clinical classification of acute myocardial infarction

Bandolier on Clinical classification of acute myocardial infarction

TRIP on Clinical classification of acute myocardial infarction

Clinical Trials

Ongoing Trials on Clinical classification of acute myocardial infarction at Clinical Trials.gov

Trial results on Clinical classification of acute myocardial infarction

Clinical Trials on Clinical classification of acute myocardial infarction at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Clinical classification of acute myocardial infarction

NICE Guidance on Clinical classification of acute myocardial infarction

NHS PRODIGY Guidance

FDA on Clinical classification of acute myocardial infarction

CDC on Clinical classification of acute myocardial infarction

Books

Books on Clinical classification of acute myocardial infarction

News

Clinical classification of acute myocardial infarction in the news

Be alerted to news on Clinical classification of acute myocardial infarction

News trends on Clinical classification of acute myocardial infarction

Commentary

Blogs on Clinical classification of acute myocardial infarction

Definitions

Definitions of Clinical classification of acute myocardial infarction

Patient Resources / Community

Patient resources on Clinical classification of acute myocardial infarction

Discussion groups on Clinical classification of acute myocardial infarction

Patient Handouts on Clinical classification of acute myocardial infarction

Directions to Hospitals Treating Clinical classification of acute myocardial infarction

Risk calculators and risk factors for Clinical classification of acute myocardial infarction

Healthcare Provider Resources

Symptoms of Clinical classification of acute myocardial infarction

Causes & Risk Factors for Clinical classification of acute myocardial infarction

Diagnostic studies for Clinical classification of acute myocardial infarction

Treatment of Clinical classification of acute myocardial infarction

Continuing Medical Education (CME)

CME Programs on Clinical classification of acute myocardial infarction

International

Clinical classification of acute myocardial infarction en Espanol

Clinical classification of acute myocardial infarction en Francais

Business

Clinical classification of acute myocardial infarction in the Marketplace

Patents on Clinical classification of acute myocardial infarction

Experimental / Informatics

List of terms related to Clinical classification of acute myocardial infarction

Cardiology Network

Discuss Clinical classification of acute myocardial infarction further in the WikiDoc Cardiology Network
Adult Congenital
Biomarkers
Cardiac Rehabilitation
Congestive Heart Failure
CT Angiography
Echocardiography
Electrophysiology
Cardiology General
Genetics
Health Economics
Hypertension
Interventional Cardiology
MRI
Nuclear Cardiology
Peripheral Arterial Disease
Prevention
Public Policy
Pulmonary Embolism
Stable Angina
Valvular Heart Disease
Vascular Medicine

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Prior MI Classification Schemes

There have been several prior classification schemes for characterizing MI:

1. Transmural (necrosis of full thickness of ventricle) vs. non transmural (necrosis of partial thickness of ventricle)

2. Q wave vs. non Q wave: Based upon the development of electrocardiographic Q waves representing electrically inert tissue.

3. ST elevation MI (STEMI) and Non ST elevation myocardial infarction (NSTEMI)

At one time it was thought that Transmural MI and Q wave MI were synonymous. However, not all Q wave MIs are transmural, and not all transmural MIs are associated with Q waves.

Likewise, not all ST elevation MIs go on to cause q waves. Non ST elevation MIs can result in q waves.

Thus, ST elevation MI should not be equated with transmural MI or q wave MI. Likewise, Non ST elevation MI should not be equated with non transmural MI or non q wave MI. These 3 designations reflect three separate but overlapping characterization schemes.

New MI Clinical Classification System

A new clinical evidence based classification system has been introduced by Thygesen K, Alpert JS, White HD, et al. and jointly sponsored by the American College of Cardiology (ACC), American Heart Association (AHA), European Society of Cardiology (ESC), and the World Heart Federation (WHF).[1]

Criteria for Diagnosis of Acute Myocardial Infarction

"The term myocardial infarction should be used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischemia. Under these conditions any one of the following criteria meets the diagnosis for acute myocardial infarction". [1]

Below are the criteria quoted from the Thygesen article:

  1. Detection of rise and/or fall of cardiac biomarkers (preferably Troponin) with at least one of the following
    a. Symptoms of ischemia
    b. EKG changes indicative of ischemia as new (ST segment / T wave changes or new left bundle branch block LBBB)
    c. Development of pathological Q waves
    d. Imaging evidence of new viable myocardium or wall motion abnormality
  2. Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischemia, accompanied by presumably new ST segment elevation, or new LBBB, and/or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, if death has occurred before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood
  3. In patients with normal baseline troponin values, a greater than 3 times increase above the 99th percentile of the upper limit of normal of cardiac biomarkers has been designated as the definition of PCI related myocardial infarction. A subtype related to documented stent thrombosis is recognized.
  4. For patients with CABG surgery; (In patients with normal baseline troponin values) increases of cardiac biomarkers greater than 5 times, (> 5 times the 99th percentile upper limit of normal) and either new pathological Q waves or new LBBB or angiographically evidence of new graft or native vessel occlusion have been designated as defining CABG surgery related myocardial infarction.
  5. Pathological findings of acute myocardial infarction.

Criteria for Prior Myocardial Infarction

If any of the following are present, then a diagnosis of prior myocardial infarction is established:[1]

  • Development of new pathological Q waves with or without symptoms
  • Imaging evidence of a region of loss of viable myocardium that is thinned and fails to contract in the absence of a non ischemic cause.
  • Pathological findings of healed or healing myocardial infarction.

Classification

Five types of MI are now recognized and classified as follows: [1]

Type 1: Spontaneous myocardial infarction related to ischemia due to a primary coronary event, such as plaque erosion and/or rupture, fissuring, or dissection.

Type 2: Myocardial infarction secondary to ischemia due to an imbalance of O2 supply and demand, as from coronary spasm or embolism, anemia, arrhythmias, hypertension, or hypotension

Type 3: Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggesting ischemia with new ST segment elevation; new left bundle branch block; or pathologic or angiographic evidence of fresh coronary thrombus (in the absence of reliable biomarker findings)

Type 4:

a. Myocardial infarction associated with Percutaneous Coronary Interventions (PCI)
b. Myocardial infarction associated with documented stent thrombosis.

Type 5: Myocardial infarction associated with Coronary Artery Bypass Graft surgery

References

  1. 1.0 1.1 1.2 1.3 Thygesen K, Alpert JS, White HD; et al. (2007). "Universal definition of myocardial infarction". Circulation. 116 (22): 2634–53. doi:10.1161/CIRCULATIONAHA.107.187397. PMID 17951284. Unknown parameter |month= ignored (help)


Template:WikiDoc Sources