Myocardial Infarction (Heart Attack)
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Heart Attack
"A heart attack occurs when the supply of blood and oxygen to an area of heart muscle is blocked, usually by a clot in a coronary artery. ...Prompt treatment of a heart attack can help prevent or limit lasting damage to the heart and can prevent sudden death. ...The sooner treatment begins, the better your chances of recovering."
Highlighted Article[Complications of an unrecognized myocardial infarction] (Ned Tijdschr Geneeskd. 2005)
"Around one-third of patients who have a myocardial infarction do not have chest pain but experience shortness of breath, autonomic nervous symptoms (sweating, nausea, vomiting), extreme and inexplicable tiredness and fainting. These atypical symptoms should suggest myocardial infarction. In order to avoid high morbidity and death from complications such as arrhythmias, heart failure, rupture and aneurysm formation it is important that a patient who has had a myocardial infarction should be treated as soon as possible ..."
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Notes
The 2007 Treatment Guidelines section will contain the 2007 published guidelines. To view Guidelines from previous years, view year 2006 Treatment Guidelines and 2005 InfoMedlinks (Articles section) or our Monthly Online Newsletter (under the Guidelines section).
Myocardial Infarction (Heart Attack)
Daily Treatment Report
Cognitive Therapy-CBT-Psychotherapy
Device Therapy
Drug stents harm severe heart attack victims "Patients given drug-coated stents after an acute heart attack are nearly five times more likely to die six months to two years later than those with bare metal forms of the arterial scaffolding, research showed on Tuesday."
Comparison of Outcome in Patients With ST-Elevation Versus Non-ST-Elevation Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry). (Am J Cardiol. 2007) "In conclusion, STEMI was associated with a higher likelihood of in-hospital death than was NSTEMI, but long-term outcomes after PCI were independent of MI type. At 1 year, associated co-morbidities were strongly associated with death and MI, whereas only angiographic characteristics predicted the need for repeat revascularization."
Two-year clinical follow-up after sirolimus-eluting versus bare-metal stent implantation assisted by systematic glycoprotein IIb/IIIa Inhibitor Infusion in patients with myocardial infarction: results from the STRATEGY study. (J Am Coll Cardiol. 2007)
Optimal Medical Therapy with or without PCI for Stable Coronary Disease (NEJM 2007) "Background In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events. … Conclusions As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy."
Drug Side-Effects and Interactions
Amiodarone use after acute myocardial infarction complicated by heart failure and/or left ventricular dysfunction may be associated with excess mortality. (Am Heart J. 2008) “CONCLUSION: In this study, amiodarone use was associated with excess early and late all-cause and cardiovascular mortality. These observational findings are in contrast to earlier randomized trials of amiodarone and need to be validated prospectively.”
Drugs
Impact of female sex on death and bleeding after fibrinolytic treatment of myocardial infarction in GUSTO V. (Arch Intern Med. 2007) "BACKGROUND: Women with acute myocardial infarction are more likely than men to experience reinfarction, bleeding, or death. This difference has been hypothesized to be due to older age, treatment delay, and comorbidities in women. Use of diagnostic and therapeutic modalities may also differ. There is controversy regarding whether female sex is an independent risk factor for death and/or bleeding."
Survival of patients discharged after acute myocardial infarction and evidence-based drug therapy. (Eur J Epidemiol. 2007) "These data demonstrate that use of evidence-based drug treatment for prevention of mortality in patients with AMI is associated with risk reduction and survival benefit. Continuous quality improvement initiatives serve to improve outcome after AMI."
Exercise
An active lifestyle improves outcome of primary angioplasty in elderly patients with acute myocardial infarction. (Am Heart J. 2007) "CONCLUSIONS: Our data indicate that an active lifestyle may favorably affect early and late outcomes of primary PTCA in the elderly population."
General Information
More Support for Chest-Compression-Only Resuscitation for Out-of-Hospital Cardiac Arrest “Two observational studies published online December 10, 2007 in Circulation concluded that the conventional method of cardiopulmonary resuscitation (CPR) that calls for mouth-to-mouth assisted ventilation is no more effective than a chest-compression-only approach [1,2]. The findings support a good deal of international research supporting use of the latter method, which is less complicated and may be more appealing to potential bystander rescuers.”
Chest Compressions Key to Revised CPR Guidelines "Maintaining blood flow to the brain and other vital organs is the key to simplified cardiopulmonary resuscitation (CPR) guidelines that emphasize chest compressions over rescue breathing, particularly for heart attack victims. In fact, the revised recommended ratio is just two breaths per every 30 chest compressions. That's twice as many compressions as was recommended in the past. "Just doing chest compressions can make a difference," explained Dr. Shukri David, chief of cardiology at Providence Hospital of St. John's Health System, in Southfield, Mich. "When you compress the chest deep enough, you create a vacuum that pulls in air as you release." However, David and other experts caution that in the case of drowning victims or people who were deprived of oxygen, rescue breaths are still necessary. Because health experts wanted to make the revised CPR guidelines as simple as possible, and they felt it might be difficult for lay people to differentiate who needed rescue breaths and who didn't, the guidelines include rescue breaths, as well as the rescue breaths-to-chest-compression ratio. "
[Monitoring after acute myocardial infarction] (Dtsch Med Wochenschr. 2007)
Nonresponse to Treatment for Depression Following Myocardial Infarction: Association With Subsequent Cardiac Events. (Am J Psychiatry. 2007)
Many Heart Attack Patients Don't Get Needed Treatment "Eligible patients most likely to miss out on emergency reperfusion included: Those whose heart attack symptoms didn't include typical symptoms such as chest pain; those who didn't reach the hospital until six or more hours after the start of their heart attack; women; people over age 75; and non-white people."
Management of non-ST-Segment Elevation Myocardial Infarction. (Med Clin North Am. 2007)
Is there a true beneficial effect of statin therapy in the acute phase of unstable angina or myocardial infarction? (Curr Vasc Pharmacol. 2007)
Faster Heart Attack Care Saving Lives "After an Indiana hospital introduced a new protocol to get heart attack patients into the cardiac catheterization lab more quickly for artery-opening procedures, patients received lifesaving care up to an hour sooner than before and suffered less heart damage, researchers report. They also had shorter hospital stays, according to a study published in the June 11 issue of Circulation. The study included patients with a type of heart attack called ST-segment elevation myocardial infarction (STEMI), which is caused by a completely blocked artery. The sooner the artery can be opened, the lower the risk of death or permanent heart damage. Emergency angioplasty -- also called percutaneous coronary intervention (PCI) -- is the preferred treatment for this kind of heart attack, according to background information in the study. "The benefit of emergency PCI depends on how quickly a patient receives treatment. However, only about a third of patients in the United States receive treatment within the recommended 90 minutes," study lead author Dr. Umesh N. Khot, a cardiologist at Indiana Heart Physicians/St. Francis Heart Center in Indianapolis, said in a prepared statement. "
Outcomes of Myocardial Infarction in Hospitals With Percutaneous Coronary Intervention Facilities (Arch Intern Med. 2007) " … our findings support routine use of PCI and evidence-based medications for these patients."
[Treatment of acute myocardial infarction in 2007] (Rev Med Suisse. 2007) "The two immediate priorities when faced with acute myocardial infarction are 1) to be able to deliver electric cardioversion in case of need and 2) to rapidly start reperfusion therapy (angioplasty or thrombolysis). During the hospital phase, antiplatelet agents are given to all, betablockers should be used if there is no heart failure, and ACE-inhibitors are mostly indicated for patients with poor hemodynamics. At discharge, in addition to instructions regarding not smoking, a balanced diet, and regular physical exercise, a statin and antiplatelet therapy remain a long-term indication for all."
An invasive strategy is associated with decreased mortality in patients 80 years and older with acute myocardial infarction. (Am J Geriatr Cardiol. 2007)
Weekend versus weekday admission and mortality from myocardial infarction. (N Engl J Med. 2007) "CONCLUSIONS: For patients with myocardial infarction, admission on weekends is associated with higher mortality and lower use of invasive cardiac procedures. Our findings suggest that the higher mortality on weekends is mediated in part by the lower rate of invasive procedures, and we speculate that better access to care on weekends could improve the outcome for patients with acute myocardial infarction."
Sex differences in the effectiveness of statins after myocardial infarction. (MAJ. 2007) "INTERPRETATION: Statin therapy after an AMI was associated with reduced rates of all-cause and cardiac mortality. The effect increased with time in both sexes, but the degree of risk reduction was less for women than for men."
Guidelines
Translating Evidence Into Guidelines and Applying Them in Practice: the Long Chain of Quality "The Guidelines are here! For those of us who focus on acute coronary syndromes (ACS)—and likely all internists and cardiologists, given the large number of patients with ACS—the arrival of the 2007 ACC/AHA Guidelines for the Management of Patients With Unstable Angina / Non–ST-Elevation Myocardial Infarction (UA/NSTEMI) is highly anticipated. There have been many advances in this field, making it difficult to keep up with the science and provide the best possible care for our patients. The chain of events between good science and improved quality of patient care is a long one, but the guidelines are the centerpiece around which improvements are based."
Doctors refine heart attack guidelines "The new guidelines suggest that stabilized and lower-risk patients get a stress test, an echo-cardiogram and other tests of heart function. These patients also should receive a number of therapies to prevent a second heart attack, including the use of ACE inhibitors -- drugs that protect the heart muscle -- and other drugs. And they place greater emphasis on smoking cessation and better control of cholesterol and blood pressure. High-risk patients will still be recommended for early intervention, such as the opening the blockages with a balloon-tipped catheter and inserting a device called a stent to keep the artery open."
Immunotherapy
Internet Sites
Treatment Information
Drug-Food-Supplement Information
DrugDigest (drug interactions)
FDA - Drug Interactions: What You Should Know
NIH - Botanical Dietary Supplements: Background Information
NIH - Drug, Supplements, and Herbal Information
NIH - Herbal Supplements: Consider Safety, Too
NIH - Vitamin and Mineral Supplement Fact Sheets
Nutrition
Effects of resveratrol treatment on cardiac remodeling following myocardial infarction. (J Pharmacol Exp Ther. 2007)
"Good Fat" OK for Heart Attack Patients "A Mediterranean-style diet high in olive oil and other "healthy" fats is just as good as the classic American Heart Association low-fat diet for the 8 million Americans who have suffered a heart attack and want to prevent a repeat, new research suggests. People on either diet had one-third the risk of suffering another heart attack, a stroke, death or other heart problem compared with heart patients eating in the usual way, the study found. "
Other
Other Treatments
Intravenous magnesium for acute myocardial infarction. (Cochrane Database Syst Rev. 2007) "AUTHORS' CONCLUSIONS: Owing to the likelihood of publication bias and marked heterogeneity of treatment effects, it is essential that the findings are interpreted cautiously. From the evidence reviewed here, we consider that: (1) it is unlikely that magnesium is beneficial in reducing mortality both in patients treated early and in patients treated late, and in patients already receiving thrombolytic therapy; (2) it is unlikely that magnesium will reduce mortality when used at high dose (>=75 mmol); (3) magnesium treatment may reduce the incidence of ventricular fibrillation, ventricular tachycardia, severe arrhythmia needing treatment or Lown 2-5, but it may increase the incidence of profound hypotension, bradycardia and flushing; and (4) the areas of uncertainty regarding the effect of magnesium on mortality remain the effect of low dose treatment (< 75 mmol) and in patients not treated with thrombolysis."
Experimental
Radiotherapy
Supplements-Vitamins-CAM
Fish oil urged for heart patients "Doctors are being advised to prescribe oily fish or omega-3 fatty acid supplements to heart attack patients. The National Institute for Health and Clinical Excellence (NICE) believes this is an effective way to cut the risk of further heart attacks. It is the first time NICE has recommended lifestyle change - alongside drugs - in guidance on preventing repeat attacks."
Effect of folic Acid on endothelial function following acute myocardial infarction. (Am J Cardiol. 2007) " Folic acid can be recommended to improve postinfarction endothelial dysfunction in patients with normo- and hyperhomocysteinemia."
Surgery
Percutaneous Coronary Intervention in the Elderly for Myocardial Infarction in the Poststent Era. (Crit Pathw Cardiol. 2007)
Percutaneous coronary intervention for late reperfusion after myocardial infarction in stable patients. (Am Heart J. 2007)
L: -carnitine as an Adjunct Therapy to Percutaneous Coronary Intervention for Non-ST Elevation Myocardial Infarction. (Cardiovasc Drugs Ther. 2007)
Does coronary angioplasty after timely thrombolysis improve microvascular perfusion and left ventricular function after acute myocardial infarction? (American Heart Journal 2007)
Impact of Time to Treatment on Myocardial Reperfusion and Infarct Size With Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction (from the EMERALD Trial). (Am J Cardiol. 2007) "In conclusion, very early reperfusion with primary PCI is associated with smaller infarct size and has a much greater impact in anterior versus nonanterior infarction. Incremental delays in reperfusion after 2 hours have less effect on infarct size. These data have implications regarding the triage of patients for primary PCI."
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