急性心肌梗死 - NEJM医学前沿
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急性心肌梗死
Acute Myocardial Infarction


Jeffrey L. Anderson ... 心脑血管疾病 • 2017.05.25
相关阅读
• 年轻女性和男性的急性心肌梗死症状 • 无症状性心肌梗死增加心力衰竭风险 • 补充供氧与复发性心肌梗死的过度风险相关 • 比伐卢定和肝素单药治疗心肌梗死的比较研究 • 纤溶和急诊PCI治疗ST段抬高型心肌梗死的比较 • 高敏肌钙蛋白阴性和非缺血性ECG可排除急性心肌梗死 • 预测急性心肌梗死风险的两项决策规则的验证

中国的急性心实践

 

乌宇亮,袁祖贻 *

西安交通大学医学院第一附属医院心内科

*通信作者

 

以往人们认为冠心病是老年病,但随着人们生活水平的提高和不良生活方式及危险因素的增多,冠心病的发病年龄提前,且发病率逐年提高。急性心肌梗死(AMI)作为冠心病的一种急症,其发病率明显增加。急性心肌梗死因其发病急、致死率高、预后差,已成为心血管医生现在及将来面临的主要挑战之一。急性心肌梗死所造成的医疗负担已经由高收入国家向中低收入国家转移1,2,其发病率与收入成明显的反比关系,在高收入国家主要是通过预防投入和血运重建来降低发病率和死亡率及改善预后3。本期的《新英格兰医学杂志》发表了一篇基于指南的急性心肌梗死院前及住院期间的治疗要点综述,对指导中国急性心肌梗死实践极有帮助4

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伴或不伴ST段抬高型急性心肌梗死(STEMI或non-STEMI)是一种常见的心脏急症,其潜在发病率和死亡率很高。在过去30年中,急性心肌梗死的管理有了显著改善,并且还在继续改善。本综述重点在于1型急性心肌梗死的首发表现和院内管理。

 

定义和分型


急性心肌梗死是一种由不稳定性缺血综合征导致的心肌坏死事件1,在实践中,该疾病的诊断和评估基于临床评价、心电图(ECG)、生化检测、有创性和无创性成像以及病理学评估。

急性心肌梗死可以根据ECG有无ST段抬高进行分类,还可以进一步被分为6种类型:冠状动脉粥样硬化血栓形成导致的梗死(1型),急性动脉粥样硬化血栓形成之外其他原因引起的血流供需不平衡导致的梗死(2型),导致猝死因而无生物标志物或ECG确认机会的梗死(3型),经皮冠状动脉介入治疗(PCI)相关的梗死(4a型),冠脉支架血栓形成相关的梗死(4b型),冠状动脉旁路移植术(CABG)相关的梗死(5型)1





作者信息

Jeffrey L. Anderson, M.D., and David A. Morrow, M.D.
From the Intermountain Medical Center Heart Institute, University of Utah School of Medicine, Salt Lake City (J.L.A.); and Brigham and Women’s Hospital, Harvard Medical School, Boston (D.A.M.). Address reprint requests to Dr. Anderson at Intermountain Medical Center Heart Institute, 5121 S. Cottonwood St., Salt Lake City, UT 84107, or at jeffreyl.anderson@imail.org.

 

参考文献

1. Thygesen K, Alpert JS, Jaffe AS, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581-1598

2. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics — 2016 update: a report from the American Heart Association. Circulation 2016;133:e38-e360

3. Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet 2015;386:2145-2191

4. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-2223

5. Yusuf S, Rangarajan S, Teo K, et al. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014;371:818-827

6. Libby P. Mechanisms of acute coronary syndromes and their implications for therapy. N Engl J Med 2013;368:2004-2013

7. Libby P, Bornfeldt KE, Tall AR. Atherosclerosis: successes, surprises, and future challenges. Circ Res 2016;118:531-534

8. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:e78-e140

9. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014;64:e139-e228

10. Morrow DA, ed. Myocardial infarction: a companion to Braunwald’s Heart Disease. St. Louis: Elsevier, 2016:2-2.

11. Morrow DA. Evidence-based algorithms using high-sensitivity cardiac troponin in the emergency department. JAMA Cardiol 2016;1:379-381

12. Volz KA, McGillicuddy DC, Horowitz GL, Sanchez LD. Creatine kinase-MB does not add additional benefit to a negative troponin in the evaluation of chest pain. Am J Emerg Med 2012;30:188-190

13. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation 2007;116:e148-e304

14. Ting HH, Krumholz HM, Bradley EH, et al. Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation 2008;118:1066-1079

15. Bagai A, Jollis JG, Dauerman HL, et al. Emergency department bypass for ST-segment-elevation myocardial infarction patients identified with a prehospital electrocardiogram: a report from the American Heart Association Mission: Lifeline program. Circulation 2013;128:352-359

16. Diercks DB, Kontos MC, Chen AY, et al. Utilization and impact of pre-hospital electrocardiograms for patients with acute ST-segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol 2009;53:161-166

17. McCabe JM, Armstrong EJ, Kulkarni A, et al. Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention–capable centers: a report from the Activate-SF registry. Arch Intern Med 2012;172:864-871

18. Montalescot G, van ’t Hof AW, Lapostolle F, et al. Prehospital ticagrelor in ST-segment elevation myocardial infarction. N Engl J Med 2014;371:1016-1027

19. Bernard SA, Smith K, Cameron P, et al. Induction of therapeutic hypothermia by paramedics after resuscitation from out-of-hospital ventricular fibrillation cardiac arrest: a randomized controlled trial. Circulation 2010;122:737-742

20. Kim F, Nichol G, Maynard C, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA 2014;311:45-52

21. Anderson JL. ST-elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Schafer AI, eds. Goldman’s Cecil medicine. 25th ed. Philadelphia: Elsevier Saunders, 2016:441-456.

22. Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol 2013;62:496-504

23. Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. J Am Coll Cardiol 2016;67:1235-1250

24. Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med 2013;369:1115-1123

25. Engstrøm T, Kelbæk H, Helqvist S, et al. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3–PRIMULTI): an open-label, randomised controlled trial. Lancet 2015;386:665-671

26. Gershlick AH, Khan JN, Kelly DJ, et al. Randomized trial of complete versus lesion-only revascularization in patients undergoing primary percutaneous coronary intervention for STEMI and multivessel disease: the CvLPRIT trial. J Am Coll Cardiol 2015;65:963-972

27. Spencer FA, Sekercioglu N, Prasad M, Lopes LC, Guyatt GH. Culprit vessel versus immediate complete revascularization in patients with ST-segment myocardial infarction-a systematic review. Am Heart J 2015;170:1133-1139

28. Svilaas T, Vlaar PJ, van der Horst IC, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med 2008;358:557-567

29. Fröbert O, Lagerqvist B, Olivecrona GK, et al. Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 2013;369:1587-1597

30. Jolly SS, Cairns JA, Yusuf S, et al. Randomized trial of primary PCI with or without routine manual thrombectomy. N Engl J Med 2015;372:1389-1398

31. Elgendy IY, Huo T, Bhatt DL, Bavry AA. Is aspiration thrombectomy beneficial in patients undergoing primary percutaneous coronary intervention? Meta-analysis of randomized trials. Circ Cardiovasc Interv 2015;8:e002258-e002258

32. Hinohara TT, Rao SV. Current state of radial artery catheterization in ST-elevation myocardial infarction. Prog Cardiovasc Dis 2015;58:241-246

33. Karrowni W, Vyas A, Giacomino B, et al. Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv 2013;6:814-823

34. Valgimigli M, Gagnor A, Calabró P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 2015;385:2465-2476

35. Mehta SR, Granger CB, Boden WE, et al. Early versus delayed invasive intervention in acute coronary syndromes. N Engl J Med 2009;360:2165-2175

36. Huber K, Bates ER, Valgimigli M, et al. Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold? Am Heart J 2014;168:611-621

37. The CURRENT–OASIS 7 Investigators. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med 2010;363:930-942

38. Mehta SR, Tanguay JF, Eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet 2010;376:1233-1243

39. Montalescot G, Bolognese L, Dudek D, et al. Pretreatment with prasugrel in non–ST-segment elevation acute coronary syndromes. N Engl J Med 2013;369:999-1010

40. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2007;357:2001-2015

41. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045-1057

42. Bhatt DL, Stone GW, Mahaffey KW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med 2013;368:1303-1313

43. Steg PG, Bhatt DL, Hamm CW, et al. Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data. Lancet 2013;382:1981-1992

44. Stone GW, McLaurin BT, Cox DA, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med 2006;355:2203-2216

45. Stone GW, Witzenbichler B, Guagliumi G, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 2008;358:2218-2230

46. Cavender MA, Sabatine MS. Bivalirudin versus heparin in patients planned for percutaneous coronary intervention: a meta-analysis of randomised controlled trials. Lancet 2014;384:599-606

47. Shahzad A, Kemp I, Mars C, et al. Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. Lancet 2014;384:1849-1858

48. Han Y, Guo J, Zheng Y, et al. Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. JAMA 2015;313:1336-1346

49. Cavender MA, Faxon DP. Can BRIGHT restore the glow of bivalirudin? JAMA 2015;313:1323-1324

50. Camm AJ, Kirchhof P, Lip GY, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010;31:2369-2429

51. Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013;381:1107-1115

52. Gibson CM, Mehran R, Bode C, et al. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med 2016;375:2423-2434

53. French JK, Hellkamp AS, Armstrong PW, et al. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol 2010;105:59-63

54. Wallentin L, Kristensen SD, Anderson JL, et al. How can we optimize the processes of care for acute coronary syndromes to improve outcomes? Am Heart J 2014;168:622-631

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