Net Guide: Myocardial Infarction

MDNG Primary CareSeptember 2010
Volume 12
Issue 9

Top resources for Myocardial Infarction

//Online CME

Acute Myocardial Infarction

Credits: 0.25

Fee: None

Expires: June 29, 2011

Multimedia: None

This interactive case-based lesson from the Cleveland Clinic Center for Continuing Education requires participants to answer a series of multiple-choice questions about a hypothetical 66-year-old male patient who is complaining of chest pain. During this activity, participants will review primary risk factors for coronary artery disease, the signs and symptoms of a patient with an acute coronary syndrome, initial treatment strategies for acute myocardial infarction, and appropriate long-term, post-MI management strategies.

Link Code: a129310

Missed Myocardial Infarction: ECG Strategies to Reduce the Risk

Credits: 2.30 (1.50 AAFP credits)

Fee: $45

Expires: June 8, 2012

Multimedia: None

This course will review the epidemiology, etiology, pathophysiology, and clinical features of acute MI; state-of-the-art diagnostic and therapeutic techniques; the differential diagnosis of acute MI; and likely and rare complications that may occur.

Link Code: a129311


Serial Assessment of Left Ventricular Remodeling by Measurement of Left Ventricular Torsion using Speckle Tracking Echocardiography in Patients with Acute Myocardial Infarction

Journal: The American Journal of Cardiology(October 2010)

Authors: Jang JY, Woo JS, Kim WS, et al.

Purpose: To determine whether left ventricular (LV) torsion assessed by speckle tracking imaging can predict progressive LV dilation after acute myocardial infarction (AMI).

Results: The authors studied 91 patients with AMI who were treated with primary coronary intervention and who underwent conventional and speckle tracking echocardiographies at initial presentation and three days and six months after first AMI. Patients were divided into two groups based on presence of LV remodeling at six months. They reported that “LV end-diastolic volume was not significantly different between the no-remodeling and remodeling groups;” however, LV torsion was “significantly decreased” in the remodeling group. They concluded that “decreased LV torsion assessed by speckle tracking echocardiography may predict late LV remodeling after reperfusion therapy after AMI.”

Link Code: a129510

Time to Rheology in Acute Myocardial Infarction: Inflammation and Erythrocyte Aggregation as a Consequence and Not Necessarily as Precursors of the DiseaseJournal: Clinical Research in Cardiology (Vol. 99, No. 10)

Authors: Steinvil A, Berliner S, Shapira I, et al.

Purpose: To explore “the correlation between the time from symptom onset to the appearance of an inflammatory response and aggregated erythrocytes in the peripheral blood” of patients with acute coronary syndromes.

Results: The authors studied 223 patients with unstable angina and 205 with acute myocardial infarction (AMI) who underwent coronary catheterization. They reported that only the AMI group exhibited a “significant time-dependant increase in the concentrations of inflammation-sensitive biomarkers” and erythrocyte aggregation.

Link Code: a129511

Mild Heart Failure Is a Mortality Marker after a Non-ST-segment Acute Myocardial InfarctionJournal: European Journal of Internal Medicine (October 2010)

Authors: Nunez-Gil IJ, Garcia-Rubira JC, Luaces M, et al.

Purpose: To assess the prognostic value of mild heart failure (HF) in non-ST-elevation myocardial infarction (NSTEMI).

Results: Researchers studies 835 patients with NSTEMI and divided them into two groups base on Killip classification category (K1 and K2). They reported that “multi-vessel coronary disease and revascularization procedures were less common” in group K2 compared with K1; patients in K2 had “a worse prognosis in terms of maximum Killip class, death, and major adverse cardiovascular events.” The authors concluded that “HF at presentation in NSTEMI is linked to a poor prognosis, with increased short-term mortality.”

Link Code: a129512

//Clinical Trials

Study to Evaluate the Safety and Efficacy of SCH 530348 in Addition to Standard of Care in Subjects with Acute Coronary Syndrome: Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRA•CER)

Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Schering-Plough and Duke University

Purpose: This study will determine whether adding an experimental drug (SCH 530348) to the existing standard of care for preventing heart attack and stroke in patients with acute coronary syndrome will yield additional benefit. Patients who have a history of severe hypertension or valvular heart disease, who are currently taking blood thinners, and/or have a history of intracranial hemorrhage are ineligible for this study.

Link Code: a129610

Study to Evaluate the Effect of Timing on the Administration of Bone Marrow Mononuclear Cells vs. Placebo in Patients with Acute Myocardial Infarction: The Transplantation in Myocardial Infarction Evaluation (TIME) Study

Study Type: Interventional

Age/Gender Requirements: 21 years (male/female)

Sponsor: National Heart, Lung, and Blood Institute

Purpose: This study will evaluate the safety and effectiveness of using adult stem cells for improving heart function in people who have had a recent heart attack and a percutaneous coronary intervention. Primary outcome is global and regional six-month left ventricular ejection fraction.

Link Code: a129611

Study to Investigate the Role of Upstream High Dose Statin Treatment in Patients with ST Segment Elevation Myocardial Infarction

Study Type: Interventional

Age/Gender Requirements: 25-90 years (male/female)

Sponsor: Western Pennsylvania Hospital and West Penn Allegheny Health System

Purpose: Researchers will investigate the role of upstream 80 mg Atorvastastin-calcium in patients who are undergoing percutaneous intervention for acute ST segment elevation myocardial infarction.

Link Code: a129612

//The Educated Patient™

Myocardial Infarction: What Is It?

This resource, part of the Pri-Med Patient Education Center, explains what happens to the heart and surrounding blood vessels during a heart attack and, depending on the location and amount of heart muscle involved, what effects it can have on a patient’s heart. Patients who visit this site can learn more about the primary risk factors for heart attack and atherosclerosis, the symptoms that may indicate the onset of a heart attack, the tests that may be used by their physicians to diagnose a heart attack or other coronary event, common-sense steps patients can take to prevent atherosclerosis and heart attack, and available treatment options and the factors that determine treatment selection.

Link Code: a129210

Mayo Clinic: Acute Myocardial Infarction (Heart Attack)

Like many sites that offer information about myocardial infarction for patients and caregivers, this resource from the May Clinic explains, using easy-to-understand language, what a heart attack is and what causes it. What makes this site stand out is the information it provides that explain how heart attack care is measured and evaluated. Patients who visit this site can read about the treatments that are “widely accepted as the most appropriate form of treatment for the majority of patients diagnosed with heart attack,” enabling them to compare the care provided by their physicians with the accepted standards of care.

Link Code: a129211

From the Network

Women with Gout Face Higher Risk of Myocardial Infarction

Study results published in Annals of the Rheumatic Diseases indicate that women with gout face a nearly 40% greater risk of acute myocardial infarction compared with men who have been diagnosed with gout.

use AJMC logo with this one

Preventing Myocardial Infarction and Stroke with a Simplified Bundle of Cardioprotective Medications

Researchers demonstrated that bundling fixed doses of a generic statin and an ACEI/ARB in a large, diverse population of patients with diabetes and/or coronary artery disease being treated in an integrated healthcare delivery system successfully reduced the risk of hospitalization for myocardial infarction and stroke.

use the EchoJournal logo with this on

How Would You Manage This Patient? Would You Anticoagulate for MI?

A search for “infarction” on the EchoJournal website retrieves a four-part collection of ultrasound videos showing an inferior wall MI in a patient who suffered a subdural hematoma, leading to non-sustained ventricular tachycardia, inferior ST segment depression, and these “wall motion abnormalities.”

Pharma Focus

Effient (prasugrel)

Clinical Trials

A Comparison of Prasugrel and Clopidogrel in Acute Coronary Syndrome Subjects with Unstable Angina/Non-ST-Elevation Myocardial Infarction Who Are Medically Managed

Study Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Eli Lilly and Company

Purpose: This study will evaluate the relative efficacy and safety of prasugrel and clopidogrel in a medically managed UA/NSTEMI ACS population. Primary outcome measure is reduction in risk of the composite endpoint of first occurrence of cardiovascular death, MI, or stroke.

Link Code: a129613

Effectiveness of Prasugrel vs. Clopidogrel in Subjects with High Platelet Reactivity on Clopidogrel following Elective Percutaneous Coronary Intervention with Implantation of Drug-eluting Stent

Study Type: Interventional

Age/Gender Requirements: 18-80 years (male/female)

Sponsor: Eli Lilly and Company

Purpose: Researchers will compare the efficacy of prasugrel versus clopidogrel for the reduction of “adverse cardiovascular outcomes in patients with high platelet reactivity on clopidogrel after successful implantation of coronary drug-eluting stents.”

Link Code: a129614

Clinical Resources

ACC/AHA STEMI Guidelines and ACC/AHA/SCAI Guidelines on PCI Incorporate Prasugrel

The ACC/AHA guidelines released late last year were updated to recommend a 60 mg loading dose of prasugrel as an alternative to clopidogrel in patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PCI).

Link Code: a129110

Antiplatelet Therapy: Which Is Right for Patients?

This page from the Independent Drug Information Service notes that the antiplatelet agent Affient (prasugrel), when combined with aspirin, has been found “to be superior to clopidogrel combined with aspirin in [acute coronary syndrome] patients who underwent percutaneous coronary intervention (PCI).” Clinicians are reminded that the combination of prasugrel and aspirin has been associated with a higher risk of major bleeding than clopidogrel plus aspirin.

Link Code: a129111

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