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==Overview==
==Overview==
[[myocardial injury]] is defined as elevated [[troponin]] concentrations without [[sign]] and [[symptom]] indicating overt [[myocardial ischemia]] and is the most common cause of increased [[troponin]] level. Traditionally, elevated [[troponin]] level was eqaul to [[myocardial infarction]]. Diagnosis of [[myocardial injury]] is a challange for clinicians. By improving the laboratory method for detecting high sensitive [[troponin]] and clinical approach to diagnosis of myocardial [[ischemia]], [[patients]] with [[myocardial injury]] due to underlying [[diseases]] were excluded and treated. Evaluation and treatment of  [[percipitant]] factors of [[myocardial injury]] including [[sepsis]], [[anemia]], [[chronic kidney disease]], [[cardiomyopathy]] are practically indicated. However,  [[patients]] with evidence of [[myocardial injury]] and [[myocardial ischemia]] both have poor short and [[long term outcome]].
[[Myocardial injury]] is defined as elevated [[troponin]] concentrations without [[sign]] and [[symptom]] indicating overt [[myocardial ischemia]] and is the most common cause of increased [[troponin]] level. Traditionally, elevated [[troponin]] level was eqaul to [[myocardial infarction]]. Diagnosis of [[myocardial injury]] is a challange for clinicians. By improving the laboratory method for detecting high sensitive [[troponin]] and clinical approach to diagnosis of myocardial [[ischemia]], [[patients]] with [[myocardial injury]] due to underlying [[diseases]] were excluded and treated. Evaluation and treatment of  [[percipitant]] factors of [[myocardial injury]] including [[sepsis]], [[anemia]], [[chronic kidney disease]], [[cardiomyopathy]] are practically indicated. However,  [[patients]] with evidence of [[myocardial injury]] and [[myocardial ischemia]] both have poor short and [[long term outcome]].


==Historical Perspective==
==Historical Perspective==

Latest revision as of 19:06, 10 March 2022

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List of terms related to Myocardial injury

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]

Synonyms and keywords: Acute myocardial injury, Chronic myocardial injury, Myocardial ischemia, troponin concentration, systemic illness

Overview

Myocardial injury is defined as elevated troponin concentrations without sign and symptom indicating overt myocardial ischemia and is the most common cause of increased troponin level. Traditionally, elevated troponin level was eqaul to myocardial infarction. Diagnosis of myocardial injury is a challange for clinicians. By improving the laboratory method for detecting high sensitive troponin and clinical approach to diagnosis of myocardial ischemia, patients with myocardial injury due to underlying diseases were excluded and treated. Evaluation and treatment of percipitant factors of myocardial injury including sepsis, anemia, chronic kidney disease, cardiomyopathy are practically indicated. However, patients with evidence of myocardial injury and myocardial ischemia both have poor short and long term outcome.

Historical Perspective

Classification

Classification Definition
Acute myocardial injury Dynamic rise and/or fall of troponin concentration

associated with cardiovascular or noncardiovascular causes

Chronic myocardial injury Stable elevated troponin concentration related to cardiovascular or noncardiovascular causes
Myocardial infarction type 1 Myocardial infarction due to plaque rupture, ulceration, or dissection
Myocardial infarction type 2 Myocardial infarction attributable to oxygen supply-demand

mismatch

Myocardial infarction type 3 Sudden cardiac death associated with myocardial infarction
Myocardial infarction type 4 Myocardial infarction associated with percutaneous intervention or stent thrombosis
Myocardial infarction type 5 Myocardial infarction related to cardiac surgery

Pathophysiology

Causes





Differentiating myocardial injury from other Diseases

Epidemiology and Demographics


Risk Factors

Common risk factors in the development of myocardial injury include:

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice



 
 
 
 
Myocardial injury
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute myocardial injury
 
 
 
Chronic myocardial injury
  • Stable but elevated troponin
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    History and physical examination
     
     
     
    History and physician examination
  • Laboratory findings
  • Creatinine, glomerular filtration rate
  • Natriuretic peptide
  • Complete blood cell count
  • C-reactive protein, erythrocyte sedimentation rate, D-dimer testing
  • Electrocardiogram
  • Transthoracic echocardiography
  • Cardiac magnetic resonance imaging
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Evidence of myocardial ischemia
     
    NO evidence of ischemia
  • Causes of Nonischemic myocardial injury:
  • Cardiovascular causes:
  • Hypertension
  • Cardiac arrhythmias
  • Acute valvular heart disease
  • Takotsubo cardiomyopathy
  • Cardiac contusions
  • Acute heart failure
  • Pulmonary embolism
  • Myocarditis
  • Aortic dissection
  • Cardiac surgery or procedures
  • Noncardiovascular causes:
  • Acute renal failure
  • Sepsis
  • Anemia
  • Hypotension
  • Hypoxia
  • Noncardiac surgery
  • Critical illness
  • Rhabdomyolysis
  • Drug-induced
  • Stroke, brain hemorrhage
  • Extreme exertion
  •  
    Cardiovascular causes of chronic myocardial injury
  • Chronic heart failure
  • Infiltrative cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Stable coronary artery disease
  • Hypertension
  • Valvular heart disease
  • Persistent arrhythmias
  • Noncardiovascular causes of chronic myocardial injury
  • Chronic renal disease
  • Pulmonary hypertension
  • Diabetes mellitus
  • Drug-induced
  • Toxin exposure
  •  
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
    Management based on the type of myocardial infarction
     
     
    Management based on the causes of myocardial injury and clinical course
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     

    History and Symptoms

    Common symptoms associated with underlying causes of myocardial injury include:

    Physical Examination

    Laboratory Findings

    Laboratory investigation consistent with the diagnosis of myocardial injury include: [3]


    Electrocardiogram

    There are no specific ECG findings associated with myocardial injury. Findings on an ECG suggestive of myocardial injury may include:[3]

    X-ray

    There are no x-ray findings associated with myocardial injury.

    Echocardiography or Ultrasound

    Echocardiography may be helpful in the diagnosis of underlying causes of myocardial injury.

    CT scan

    There are no CT scan findings associated with myocardial injury. However, a CT scan may be helpful in suspicion of pulmonary thromboembolism or aortic dissection.

    MRI

    Cardiac MRI may be helpful when there is clinically suspicion of myocarditis or infiltrative cardiomyopathy as the underlying causes of myocardial injury.

    Other Imaging Findings

    There are no other imaging findings associated with myocardial injury.

    Other Diagnostic Studies

    There are no other diagnostic studies associated with myocardial injury.

    Treatment

    Medical Therapy


    Surgery

    Surgical intervention is not recommended for the management of myocardial injury.

    Primary Prevention

    There are no established measures for the primary prevention of myocardial injury.

    Secondary Prevention

    There are no established measures for the secondary prevention of myocardial injury.

    References

    1. Perry SV (April 2008). "Background to the discovery of troponin and Setsuro Ebashi's contribution to our knowledge of the mechanism of relaxation in striated muscle". Biochem Biophys Res Commun. 369 (1): 43–8. doi:10.1016/j.bbrc.2007.11.185. PMID 18365325.
    2. Antman, Elliott; Bassand, Jean-Pierre; Klein, Werner; Ohman, Magnus; Lopez Sendon, Jose Luis; Rydén, Lars; Simoons, Maarten; Tendera, Michal (2000). "Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction". Journal of the American College of Cardiology. 36 (3): 959–969. doi:10.1016/S0735-1097(00)00804-4. ISSN 0735-1097.
    3. 3.0 3.1 3.2 3.3 3.4 McCarthy, Cian P.; Raber, Inbar; Chapman, Andrew R.; Sandoval, Yader; Apple, Fred S.; Mills, Nicholas L.; Januzzi, James L. (2019). "Myocardial Injury in the Era of High-Sensitivity Cardiac Troponin Assays". JAMA Cardiology. 4 (10): 1034. doi:10.1001/jamacardio.2019.2724. ISSN 2380-6583.
    4. Twerenbold, R.; Jaffe, A.; Reichlin, T.; Reiter, M.; Mueller, C. (2012). "High-sensitive troponin T measurements: what do we gain and what are the challenges?". European Heart Journal. 33 (5): 579–586. doi:10.1093/eurheartj/ehr492. ISSN 0195-668X.
    5. Januzzi, James; Gaggin, Hanna; Wolf, Myles; Christenson, Robert H; Hise, Michael; Duh, Show-Hong; Kelley, Walter; Seliger, Stephen L; deFilippi, Christopher (2012). "Interpreting Cardiac Troponin Results from High-Sensitivity Assays in Chronic Kidney Disease without Acute Coronary Syndrome". Clinical Chemistry. 58 (9): 1342–1351. doi:10.1373/clinchem.2012.185322. ISSN 0009-9147.
    6. Chin, C. W. L.; Shah, A. S. V.; McAllister, D. A.; Joanna Cowell, S.; Alam, S.; Langrish, J. P.; Strachan, F. E.; Hunter, A. L.; Maria Choy, A.; Lang, C. C.; Walker, S.; Boon, N. A.; Newby, D. E.; Mills, N. L.; Dweck, M. R. (2014). "High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis". European Heart Journal. 35 (34): 2312–2321. doi:10.1093/eurheartj/ehu189. ISSN 0195-668X.
    7. 7.0 7.1 Sandoval, Yader; Smith, Stephen W.; Sexter, Anne; Thordsen, Sarah E.; Bruen, Charles A.; Carlson, Michelle D.; Dodd, Kenneth W.; Driver, Brian E.; Hu, Yan; Jacoby, Katherine; Johnson, Benjamin K.; Love, Sara A.; Moore, Johanna C.; Schulz, Karen; Scott, Nathaniel L.; Apple, Fred S. (2017). "Type 1 and 2 Myocardial Infarction and Myocardial Injury: Clinical Transition to High-Sensitivity Cardiac Troponin I". The American Journal of Medicine. 130 (12): 1431–1439.e4. doi:10.1016/j.amjmed.2017.05.049. ISSN 0002-9343.
    8. 8.0 8.1 Aimo, Alberto; Januzzi, James L.; Vergaro, Giuseppe; Ripoli, Andrea; Latini, Roberto; Masson, Serge; Magnoli, Michela; Anand, Inder S.; Cohn, Jay N.; Tavazzi, Luigi; Tognoni, Gianni; Gravning, Jørgen; Ueland, Thor; Nymo, Ståle H.; Brunner-La Rocca, Hans-Peter; Genis, Antoni Bayes; Lupón, Josep; de Boer, Rudolf A.; Yoshihisa, Akiomi; Takeishi, Yasuchika; Egstrup, Michael; Gustafsson, Ida; Gaggin, Hanna K.; Eggers, Kai M.; Huber, Kurt; Tentzeris, Ioannis; Tang, Wai H.W.; Grodin, Justin; Passino, Claudio; Emdin, Michele (2018). "Prognostic Value of High-Sensitivity Troponin T in Chronic Heart Failure". Circulation. 137 (3): 286–297. doi:10.1161/CIRCULATIONAHA.117.031560. ISSN 0009-7322.
    9. . doi:10.3969/j.issn.1671-5411.2014.02.011. Missing or empty |title= (help)
    10. Kubo, Toru; Kitaoka, Hiroaki; Yamanaka, Shigeo; Hirota, Takayoshi; Baba, Yuichi; Hayashi, Kayo; Iiyama, Tatsuo; Kumagai, Naoko; Tanioka, Katsutoshi; Yamasaki, Naohito; Matsumura, Yoshihisa; Furuno, Takashi; Sugiura, Tetsuro; Doi, Yoshinori L. (2013). "Significance of High-Sensitivity Cardiac Troponin T in Hypertrophic Cardiomyopathy". Journal of the American College of Cardiology. 62 (14): 1252–1259. doi:10.1016/j.jacc.2013.03.055. ISSN 0735-1097.
    11. Januzzi, James L.; Suchindran, Sunil; Coles, Adrian; Ferencik, Maros; Patel, Manesh R.; Hoffmann, Udo; Ginsburg, Geoffrey S.; Douglas, Pamela S. (2019). "High-Sensitivity Troponin I and Coronary Computed Tomography in Symptomatic Outpatients With Suspected CAD". JACC: Cardiovascular Imaging. 12 (6): 1047–1055. doi:10.1016/j.jcmg.2018.01.021. ISSN 1936-878X.
    12. Aeschbacher, Stefanie; Schoen, Tobias; Bossard, Matthias; van der Lely, Stephanie; Glättli, Kathrin; Todd, John; Estis, Joel; Risch, Martin; Mueller, Christian; Risch, Lorenz; Conen, David (2015). "Relationship Between High-Sensitivity Cardiac Troponin I and Blood Pressure Among Young and Healthy Adults". American Journal of Hypertension. 28 (6): 789–796. doi:10.1093/ajh/hpu226. ISSN 0895-7061.
    13. Røsjø, Helge; Andreassen, Johanna; Edvardsen, Thor; Omland, Torbjørn (2011). "Prognostic Usefulness of Circulating High-Sensitivity Troponin T in Aortic Stenosis and Relation to Echocardiographic Indexes of Cardiac Function and Anatomy". The American Journal of Cardiology. 108 (1): 88–91. doi:10.1016/j.amjcard.2011.02.346. ISSN 0002-9149.
    14. van den Bos, E. J.; Constantinescu, A. A.; van Domburg, R. T.; Akin, S.; Jordaens, L. J.; Kofflard, M. J. M. (2011). "Minor elevations in troponin I are associated with mortality and adverse cardiac events in patients with atrial fibrillation". European Heart Journal. 32 (5): 611–617. doi:10.1093/eurheartj/ehq491. ISSN 0195-668X.
    15. Apple, Fred S.; Murakami, MaryAnn M.; Pearce, Lesly A.; Herzog, Charles A. (2002). "Predictive Value of Cardiac Troponin I and T for Subsequent Death in End-Stage Renal Disease". Circulation. 106 (23): 2941–2945. doi:10.1161/01.CIR.0000041254.30637.34. ISSN 0009-7322.
    16. Heresi, G.A.; Tang, W.H.W.; Aytekin, M.; Hammel, J.; Hazen, S.L.; Dweik, R.A. (2012). "Sensitive cardiac troponin I predicts poor outcomes in pulmonary arterial hypertension". European Respiratory Journal. 39 (4): 939–944. doi:10.1183/09031936.00067011. ISSN 0903-1936.
    17. Riley, Elise D.; Hsue, Priscilla Y.; Vittinghoff, Eric; Wu, Alan H.B.; Coffin, Phillip O.; Moore, Peter K.; Lynch, Kara L. (2017). "Higher prevalence of detectable troponin I among cocaine-users without known cardiovascular disease". Drug and Alcohol Dependence. 172: 88–93. doi:10.1016/j.drugalcdep.2016.11.039. ISSN 0376-8716.
    18. Segre, Carlos Alexandre Wainrober; Hueb, Whady; Garcia, Rosa Maria Rahmi; Rezende, Paulo Cury; Favarato, Desiderio; Strunz, Celia Maria Cassaro; Sprandel, Marília da Costa Oliveira; Roggério, Alessandra; Carvalho, Ana Luiza de Oliveira; Maranhão, Raul Cavalcante; Ramires, José Antonio Franchini; Filho, Roberto Kalil (2015). "Troponin in diabetic patients with and without chronic coronary artery disease". BMC Cardiovascular Disorders. 15 (1). doi:10.1186/s12872-015-0051-z. ISSN 1471-2261.
    19. Bellotto, Fabio; Fagiuoli, Stefano; Pavei, Andrea; Gregory, Shawn A.; Cati, Arianna; Silverj, Elisabetta; Plebani, Mario; Zaninotto, Martina; Mancuso, Tommaso; Iliceto, Sabino (2005). "Anemia and ischemia: Myocardial injury in patients with gastrointestinal bleeding". The American Journal of Medicine. 118 (5): 548–551. doi:10.1016/j.amjmed.2005.01.026. ISSN 0002-9343.
    20. Puelacher, Christian; Lurati Buse, Giovanna; Seeberger, Daniela; Sazgary, Lorraine; Marbot, Stella; Lampart, Andreas; Espinola, Jaqueline; Kindler, Christoph; Hammerer, Angelika; Seeberger, Esther; Strebel, Ivo; Wildi, Karin; Twerenbold, Raphael; du Fay de Lavallaz, Jeanne; Steiner, Luzius; Gurke, Lorenz; Breidthardt, Tobias; Rentsch, Katharina; Buser, Andreas; Gualandro, Danielle M.; Osswald, Stefan; Mueller, Christian; Seeberger, Manfred; Christ-Crain, Mirjam; Cuculi, Florim; Badertscher, Patrick; Nestelberger, Thomas; Wussler, Desiree; Flores, Dayana; Boeddinghaus, Jasper; Sabti, Zaid; Giménez, Maria Rubini; Kozhuharov, Nikola; Shrestha, Samyut; Kloos, Wanda; Lohrmann, Jens; Reichlin, Tobias; Freese, Michael; Meissner, Kathrin; Kaiser, Christoph; Buser, Andreas (2018). "Perioperative Myocardial Injury After Noncardiac Surgery". Circulation. 137 (12): 1221–1232. doi:10.1161/CIRCULATIONAHA.117.030114. ISSN 0009-7322.
    21. Lim, Wendy (2006). "Elevated Cardiac Troponin Measurements in Critically Ill Patients". Archives of Internal Medicine. 166 (22): 2446. doi:10.1001/archinte.166.22.2446. ISSN 0003-9926.
    22. Punukollu, Gopikrishna; Gowda, Ramesh M; Khan, Ijaz A; Mehta, Nirav J; Navarro, Victor; Vasavada, Balendu C; Sacchi, Terrence J (2004). "Elevated serum cardiac troponin I in rhabdomyolysis". International Journal of Cardiology. 96 (1): 35–40. doi:10.1016/j.ijcard.2003.04.053. ISSN 0167-5273.
    23. Lee, Kuan Ken; Noaman, Ala; Vaswani, Amar; Gibbins, Matthew; Griffiths, Megan; Chapman, Andrew R.; Strachan, Fiona; Anand, Atul; McAllister, David A.; Newby, David E.; Gray, Alasdair J.; Mills, Nicholas L.; Shah, Anoop S.V. (2019). "Prevalence, Determinants, and Clinical Associations of High-Sensitivity Cardiac Troponin in Patients Attending Emergency Departments". The American Journal of Medicine. 132 (1): 110.e8–110.e21. doi:10.1016/j.amjmed.2018.10.002. ISSN 0002-9343.
    24. Sarkisian, Laura; Saaby, Lotte; Poulsen, Tina S.; Gerke, Oke; Jangaard, Nikolaj; Hosbond, Susanne; Diederichsen, Axel C.P.; Thygesen, Kristian; Mickley, Hans (2016). "Clinical Characteristics and Outcomes of Patients with Myocardial Infarction, Myocardial Injury, and Nonelevated Troponins". The American Journal of Medicine. 129 (4): 446.e5–446.e21. doi:10.1016/j.amjmed.2015.11.006. ISSN 0002-9343.
    25. Puelacher, Christian; Bollen Pinto, Bernardo; Mills, Nicholas L.; Duceppe, Emmanuelle; Popova, Ekaterine; Duma, Andreas; Nagele, Peter; Omland, Torbjørn; Hammerer-Lercher, Angelika; Lurati Buse, Giovanna (2021). "Expert consensus on peri-operative myocardial injury screening in noncardiac surgery". European Journal of Anaesthesiology. 38 (6): 600–608. doi:10.1097/EJA.0000000000001486. ISSN 0265-0215.
    26. Apple, Fred S; Ler, Ranka; Young, Amy; Brunelli, Steven M; Gilbertson, David; Wu, Alan H B; Hu, Yan; Cao, Jing; Love, Sara A; Herzog, Charles A; Sandoval, Yader (2016). "Prognostic Value of Serial Changes in High-Sensitivity Cardiac Troponin I and T over 3 Months Using Reference Change Values in Hemodialysis Patients". Clinical Chemistry. 62 (4): 631–638. doi:10.1373/clinchem.2015.251835. ISSN 0009-9147.
    27. La Vecchia, L (2004). "Increased cardiac troponin I on admission predicts in-hospital mortality in acute pulmonary embolism". Heart. 90 (6): 633–637. doi:10.1136/hrt.2003.019745. ISSN 0007-0769.
    28. Kadesjo, Erik; Roos, Andreas; Siddiqui, Anwar J.; Desta, Liyew; Lundback, Magnus; Holzmann, Martin (2019). "ACUTE VERSUS CHRONIC MYOCARDIAL INJURY AND OUTCOMES". Journal of the American College of Cardiology. 73 (9): 105. doi:10.1016/S0735-1097(19)30713-2. ISSN 0735-1097.
    29. Ilva, Tuomo J.; Eskola, Markku J.; Nikus, Kjell C.; Voipio-Pulkki, Liisa-Maria; Lund, Juha; Pulkki, Kari; Mustonen, Harri; Niemelä, Kari O.; Karhunen, Pekka J.; Porela, Pekka (2010). "The Etiology and Prognostic Significance of Cardiac Troponin I Elevation in Unselected Emergency Department Patients". The Journal of Emergency Medicine. 38 (1): 1–5. doi:10.1016/j.jemermed.2007.09.060. ISSN 0736-4679.
    30. Chapman, Andrew R.; Shah, Anoop S.V.; Lee, Kuan Ken; Anand, Atul; Francis, Oliver; Adamson, Philip; McAllister, David A.; Strachan, Fiona E.; Newby, David E.; Mills, Nicholas L. (2018). "Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury". Circulation. 137 (12): 1236–1245. doi:10.1161/CIRCULATIONAHA.117.031806. ISSN 0009-7322.
    31. Bjurman, Christian; Larsson, Mårten; Johanson, Per; Petzold, Max; Lindahl, Bertil; Fu, Michael L.X.; Hammarsten, Ola (2013). "Small Changes in Troponin T Levels Are Common in Patients With Non–ST-Segment Elevation Myocardial Infarction and Are Linked to Higher Mortality". Journal of the American College of Cardiology. 62 (14): 1231–1238. doi:10.1016/j.jacc.2013.06.050. ISSN 0735-1097.
    32. Ford, Ian; Shah, Anoop S.V.; Zhang, Ruiqi; McAllister, David A.; Strachan, Fiona E.; Caslake, Muriel; Newby, David E.; Packard, Chris J.; Mills, Nicholas L. (2016). "High-Sensitivity Cardiac Troponin, Statin Therapy, and Risk of Coronary Heart Disease". Journal of the American College of Cardiology. 68 (25): 2719–2728. doi:10.1016/j.jacc.2016.10.020. ISSN 0735-1097.
    33. Devereaux, P J; Duceppe, Emmanuelle; Guyatt, Gordon; Tandon, Vikas; Rodseth, Reitze; Biccard, Bruce M; Xavier, Denis; Szczeklik, Wojciech; Meyhoff, Christian S; Vincent, Jessica; Franzosi, Maria Grazia; Srinathan, Sadeesh K; Erb, Jason; Magloire, Patrick; Neary, John; Rao, Mangala; Rahate, Prashant V; Chaudhry, Navneet K; Mayosi, Bongani; de Nadal, Miriam; Iglesias, Pilar Paniagua; Berwanger, Otavio; Villar, Juan Carlos; Botto, Fernando; Eikelboom, John W; Sessler, Daniel I; Kearon, Clive; Pettit, Shirley; Sharma, Mukul; Connolly, Stuart J; Bangdiwala, Shrikant I; Rao-Melacini, Purnima; Hoeft, Andreas; Yusuf, Salim; Devereaux, P.J.; Duceppe, Emmanuelle; Bangdiwala, Shrikant I.; Connolly, Stuart; Eikelboom, John; Guyatt, Gordon; Kearon, Clive; Pettit, Shirley; Pogue, Janice; Rodseth, Reitze; Sessler, Daniel I.; Vincent, Jessica; Yusuf, Salim; Vincent, Jessica; Di Diodato, Sara; Gasic, Zora; Mastrangelo, Louise J.; Molnar, Sarah H.; Pettit, Shirley; Swanson, Jennifer L.; Tosh, Makayla L.; Wells, Jennifer R.; Botto, Fernando; Diaz, Rafael; Chow, Clara K.; Berwanger, Otavio; Gonzales, Beatriz; Devereaux, P.J.; Tandon, Vikas; Villar, Juan Carlos; Vásquez, Skarlet; Jansky, Petr; Dušek, Radovan; Meyhoff, Christian S.; Coriat, Pierre; Hoeft, Andreas; Wittmann, Maria; Yonga, Gerald; Xavier, Denis; Rao, Mangala; Mathur, Nandini; Franzosi, Maria Grazia; Seletti, Elena; Malaga, German; Tumanan-Mendoza, Bernadette A.; Tagle, Maria Pamela A.; Szczeklik, Wojciech; Biccard, Bruce M.; Alonso-Coello, Pablo; Popova, Ekaterine; Shields, Martin; Sessler, Daniel I.; Devereaux, P.J.; Biccard, Bruce M.; Connolly, Stuart; Duceppe, Emmanuelle; Eikelboom, John; Guyatt, Gordon; Hoeft, Andreas; Jansky, Petr; Kearon, Clive; Le Manach, Yannick; Moayyedi, Paul; Pettit, Shirley; Pogue, Janice; Rodseth, Reitze; Sessler, Daniel I.; van Zanten, Sander; Villar, Juan Carlos; Vincent, Jessica; Yusuf, Salim; Devereaux, P.J.; Alonso-Coello, Pablo; Berwanger, Otavio; Biccard, Bruce M.; Botto, Fernando; Chow, Clara K.; Connolly, Stuart; Coriat, Pierre; Diaz, Rafael; Duceppe, Emmanuelle; Eikelboom, John; Fleischmann, Edith; Franzosi, Maria Grazia; Garg, Amit; Guyatt, Gordon; Hoeft, Andreas; Jansky, Petr; Karaye, Kamilu; Kearon, Clive; Le Manach, Yannick; Malaga, German; McFalls, Edward; Meyhoff, Christian S.; Moayyedi, Paul; Pettit, Shirley; Pogue, Janice; Rodseth, Reitze; Sessler, Daniel I.; Sigamani, Alben; Shields, Martin; Szczeklik, Wojciech; Tumanan-Mendoza, Bernadette A.; van Zanten, Sander; Villar, Juan Carlos; Vincent, Jessica; Xavier, Denis; Yonga, Gerald; Yusuf, Salim; Connolly, Stuart; Belley-Côté, Emilie; Biedroń, Grzegorz; Borges, Flavia; Frosi Stella, Steffan; Haarmark Nielsen, Christian; Leong, Darryl P.; Meyhoff, Christian S.; Spence, Jessica; Tran, Allen; Wawrzycka-Adamczyk, Katarzyna; Yang, Stephen S.; Yung, Terence; Wyse, D. George; Cheng, Davy; Johnstone, David E.; Wells, George A.; Joseph, Philip; Patel, Ameen; Leong, Darryl P.; Gregus, Krysten; Lawrence, Kelly; Doharris, Lindsay; Conen, David; Cheung, Jason; Douketis, Jim; Wright, Douglas; Wikkerink, Spencer; Dechert, William; Panju, Mohamed; Azzam, Khalid; Rapanos, Theodore; Van Helder, Tomas; Shroff, Anjali; Hare, Jacqueline; Kidane, Biniam; Nguyen, Thang; Leydier, Larissa; Bayaraa, Vanessa; Parlow, Joel; DuMerton, Deborah A.; Thakrar, Amar; Shelley, Jessica; Deligne, Benoit; Carling, Roberta Daila; Mrkobrada, Marko; Dresser, George K.; Jacka, Michael J.; Garg, Amit; Hornstein, David; Winkelaar, Gerrit B.; Haider, Zoeb Hussain; Lanjewar, Pravina Prashant; Varughese, Valsamma; Calton, Rajneesh; Ahuja, Hemani; George, Preetha; Sharma, Ambika; Bhatt, Keyur Sureshchandra; Mangukiya, Dhaval Odhavajibhai; Nandaniya, Karshan Vira; Parekh, Viral Vasantrai; Pillai, Ashok Bhaskaran; Menon, Vidya P.; Desai, Sanjay Channappa; Sidhu, Ravinder Singh; Gupta, Sandeep Kumar; George, Robbie K.; Gurunath, T.R.; Drummond, Leanne W.; Torborg, Alexandra M.; Küsel, Belinda S.; Naidoo, Prebashini; Naidoo, Datshana P.; Rajah, Chantal; Farina, Zane; von Rahden, Richard Peter; Gumede, Simphiwe; Chishala, Chishala; Coetzee, Ettienne; Dyer, Robert A.; Diedericks, Johan; Bielański, Piotr; Kaczmarek, Bogusz; Studzińska, Dorota; Zaniewski, Maciej; Libura, Marek Józef; Zacharias-Nalichowski, Tomasz Mikołaj; Sega, Aurelia A.S.; Salwa, Jakub; Kózka, Mateusz; Górka, Jacek; Wludarczyk, Anna; Nowak-Kózka, Ilona; Grudzień, Paweł Szczepan; Gucwa, Jaroslaw W.; Słowiaczek, Michał Piotr; Dobosz, Paweł P.D.; Gögenur, Ismail; Eriksen, Jens Ravn; Borup, Tine; Kirkegaard, Tove; Isbye, Dan; Sonne, Asger; Rasmussen, Lars S.; Pedersen, Sofie; Troensegaard, Hannibal; Duus, Camilla L.; Halle, Benedikte M.; Gundel, Ossian N.; Bernholm, Katrine F.; Martinsen, Kristian Rønsholt; Pedersen, Søren; Itenov, Theis S.; Camio, Elena; Vázquez, Carles; Matarin, Silvia; Cano, Esther; Álvarez-García, Jesús; India, Inmaculada; González-Osuna, Aránzazu; Vives, Marc; Rosselló, Elena; Serrano, Ana B.; Turiel, Maurizio; Drago, Lorenzo; Colombo, Chiara; Marra, Federica; Mos, Lucio; Arteni, Franco; Lembo, Rosalba; Ortalda, Alessandro; Passarani, Simonetta; Mokini, Zhirajr; Figueiredo, Estevao Lanna; Werner, Gustavo Fonseca; Petriz, Joao Luiz; Maia, Lilia Nigro; Bergo, Ricardo R.; Precoma, Dalton Bertolim; Saraiva, José Francisco Kerr; Vilamajo, Oscar Gomez; Allegrini, Eduardo; Benzadón, Mariano; Parody, Maria Leonor; Duronto, Ernesto A.; Ingaramo, Adrián C.; Parra, Gustavo Adolfo; Novoa, Danny; Miller, Scott A.; Thomas, Sabu; Karlapudi, Sudhakar P.; Bourji, Mohamad H.; Banerjee, Subhash; Gupta, Anita; Opole, Isaac O.; Fischer, Michal; Jansky, Petr; Mendoza, Victor Lecaros; Reyes, Eugenio Borja; Pierson, Richard J.; Shields, Martin O.; Chow, Clara K.; Coriat, Pierre; Piriou, Vincent; Wittmann, Maria; Zacharowski, Kai; Yonga, Gerald; Rotta-Rotta, Aida; Paper, Main; Devereaux, P.J.; Duceppe, Emmanuelle; Guyatt, Gordon; Tandon, Vikas; Rodseth, Reitze; Biccard, Bruce M.; Xavier, Denis; Szczeklik, Wojciech; Meyhoff, Christian S.; Vincent, Jessica; Franzosi, Maria Grazia; Srinathan, Sadeesh K.; Erb, Jason; Magloire, Patrick; Neary, John; Rao, Mangala; Rahate, Prashant; Chaudhry, Navneet; Mayosi, Bogani; de Nadal, Miriam; Paniagua Iglesias, Pilar; Berwanger, Otavio; Villar, Juan Carlos; Botto, Fernando; Eikelboom, John; Sessler, Daniel I.; Kearon, Clive; Pettit, Shirley; Sharma, Mike; Connolly, Stuart; Bangdiwala, Shrikant I.; Rao-Melacini, Purnima; Hoeft, Andreas; Yusuf, Salim (2018). "Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE): an international, randomised, placebo-controlled trial". The Lancet. 391 (10137): 2325–2334. doi:10.1016/S0140-6736(18)30832-8. ISSN 0140-6736.
    34. Januzzi, James L.; Butler, Javed; Jarolim, Petr; Sattar, Naveed; Vijapurkar, Ujjwala; Desai, Mehul; Davies, Michael J. (2017). "Effects of Canagliflozin on Cardiovascular Biomarkers in Older Adults With Type 2 Diabetes". Journal of the American College of Cardiology. 70 (6): 704–712. doi:10.1016/j.jacc.2017.06.016. ISSN 0735-1097.


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