Acute Coronary Syndrome and Myocardial Infarction - Related Resources

Cochrane reviews

Drug therapy

Nitrates administered within 24 hours of symptom onset in myocardial infarction appear to decrease day 2 all-cause mortality (4 to 8 deaths prevented per 1000). Continuation of nitrates beyond day 2 does not reduce mortality Early Treatment with Nitrates in Acute Myocardial Infarction.
Beta-blockers started within 24 hours of symptom onset appear not to reduce all-cause mortality after short-term use at 10 days in acute myocardial infarction Early Treatment with Beta-Blockers in Acute Myocardial Infarction.
Calcium channel blockers started within 24 hours of symptom onset in acute myocardial infarction may not decrease mortality and a non-significant trend towards increased mortality is seen after short-term use of these drugs at 10 days. Calcium channel blockers administered after acute stroke seem not to affect mortality, although the evidence is insufficient Early Treatment with Calcium Channel Blockers in Acute Cardiovascular Event.
High dose (>=75 mmol) magnesium does not reduce mortality in patients receiving thrombolytic therapy for acute myocardial infarction. It may reduce the incidence of ventricular fibrillation, ventricular tachycardia and severe arrhythmia, but it may also increase the incidence of profound hypotension, bradycardia and flushing Intravenous Magnesium for Acute Myocardial Infarction.
Fondaparinux is associated with reduced rates of major and minor bleeding compared to enoxaparin in acute coronary syndromes but it appears to be associated with an increased risk of catheter thrombosis in patients undergoing percutaneous coronary intervention Fondaparinux for Acute Coronary Syndromes.
Compared to placebo, heparins for acute coronary syndromes in addition to standard therapy with aspirin prevent myocardial infarction, but not mortality Low Molecular Weight Heparins for Acute Coronary Syndromes.
GP IIb/IIIa blockers reduce the risk of death at 30 days and the risk of death or MI at 30 days and 6 months in patients submitted to percutaneous coronary angioplasty, at a price of an increase in the risk of severe bleeding. For patients with unstable angina or non-ST-segment elevation infarction, there is only slight advantage in the reduction of death or MI, but no reduction in mortality Platelet Glycoprotein Iib/Iiia Receptor Antagonists in Cardiovascular Disease.

Surgery

Incentive spirometry may not be effective in reducing pulmonary complications and in decreasing the negative effects on pulmonary function in patients undergoing coronary artery bypass graft (CABG) Incentive Spirometry for Preventing Pulmonary Complications after Coronary Artery Bypass Graft.
CABG may be superior to PTCA in terms of morbidity outcome and similar in terms of mortality. CABG patients may be less likely to need re-intervention than those treated using angioplasty with stents Cabg Versus Ptca in Multi-Vessel Coronary Disease.
Autologous stem/progenitor cells seem to lead to some improvements over standard treatment as measured by tests of heart function in the short and long term in patients with acute myocardial infarction, although the evidence is insufficientStem Cell Treatment for Acute Myocardial Infarction.

Lifestyle and counselling

Patient education of coronary heart disease patients might possibly be beneficial compared to control but the evidence is insufficient Patient Education in the Management of Coronary Heart Disease.
Psychological interventions may produce small to moderate reductions in depression and anxiety in coronary heart disease patients Psychological Interventions for Coronary Heart Disease.
Interventions using counselling and education aimed at behaviour change may not reduce total or coronary heart disease mortality or clinical events in general populations but may be effective in reducing mortality in high-risk hypertensive and diabetic populationsMultiple Risk Factor Interventions for Primary Prevention of Coronary Heart Disease.
Dietary or supplemental omega 3 fats may not alter total mortality, combined cardiovascular events or cancers in people with, or at high risk of, cardiovascular disease or in the general population Omega-3 Fatty Acids for Prevention of Cardiovascular Disease.
Dietary advice from health personnel appears to be effective in reducing blood lipid levels, blood pressure and dietary fat intake, and increasing fruit and vegetable intake. Effect of Dietary Interventions on Diet and Cardiovascular Risk Factors.
Low glycaemic index diets may slightly reduce total cholesterol and HbA1c, but evidence is insufficient to recommend such diets for the purpose of improving risk factors for CHD Low Glycaemic Index Diets for Cardiovascular Disease.

Others

Routine oxygen therapy in patients with uncomplicated acute myocardial infarction (AMI) may not be beneficial and might possibly be harmfulOxygen Therapy for Acute Myocardial Infarction.

Other evidence summaries

Drug therapy

Long-term use of aspirin dosages greater than 75 to 81 mg/d in the setting of cardiovascular disease prevention appear not to better prevent events but is associated with increased risks of gastrointestinal bleeding Aspirin Dose for the Prevention of Cardiovascular Disease.
Except for patients with a mechanical heart valve, the benefits of oral anticoagulant (OAC) therapy plus aspirin in reducing thromboembolic events appear to be unclear compared with OAC alone, and there may be increased risk of major bleeding Combined Aspirin-Oral Anticoagulant Therapy Compared with Oral Anticoagulant Therapy Alone Among Patients at Risk for Cardiovascular Disease.
Aspirin and antilipemic agents appear to reduce reocclusion after coronary artery bypass surgery, and angiotensin-converting enzyme inhibitors may decrease ischaemic events Medical Treatments after Coronary Artery Bypass Surgery.
Compared with non aspirin-resistant patients, patients with cardiovascular disease who are aspirin resistant may have a four-fold increased risk of adverse cardiovascular outcomes while taking aspirin. This risk seems not to be reduced by currently used adjunctive antiplatelet agents Aspirin Resistance and Risk of Cardiovascular Morbidity.
Intensive lipid lowering with high-dose statin therapy appears to provide a benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events in patients with stable coronary heart disease or acute coronary syndrome Intensive Versus Moderate Statin Therapy.
There is insufficient evidence on the effect of nitrates in the prevention of death or myocardial infarction in patients with unstable angina. However, nitrates are effective in pain relief and remain the first-line treatment together with heparin and aspirin in unstable angina Nitrates in Unstable Angina.
Beta-blockers and calcium antagonists appear to provide similar outcomes, but beta-blockers fewer adverse effects Beta-Blockers, Calcium Antagonists, or Nitrates for Stable Angina.
Sotalol increases mortality in patients with myocardial infarction and left ventricular dysfunction Sotalol after Myocardial Infarction.
Verapamil use appears not to be associated with harm in patients with myocardial infarction Verapamil in Patients with Cardiovascular Disease.
In patients with coronary disease, the use of short-acting nifedipine in moderate to high doses may cause an increase in total mortality Dose-Related Mortality in Patients with Coronary Heart Disease Using Nifedipine.
Low-molecular weight heparin, administered in hospital subcutaneously, as an adjunct to thrombolysis in ST-elevation myocardial infarction, appears to be more effective than placebo and at least as effective and safe as intravenous unfractionated heparin for reducing cardiovascular events Low-Molecular Weight Heparin in Patients with Acute Myocardial Infarction Treated with Thrombolytic Therapy.
Among patients with ST-elevation myocardial infarction (STEMI) treated with thrombolysis, low-molecular-weight heparins (LMWHs), compared to unfractionated heparin (UFH), appear to be associated with a reduction in reinfarction and a trend towards reduced mortality at 30-day follow-up, but with higher risk of major bleeding complications Low-Molecular-Weight-Heparins Compared to Unfractionated Heparin in ST-Segment Elevation Myocardial Infarction Treated with Thrombolysis.
Abciximab reduces death and reinfarction rates in patients undergoing primary stenting for acute ST-elevation myocardial infarction (STEMI) Abciximab in Primary Coronary Stenting of ST-Elevation Myocardial Infarction.
Reteplase appears to be at least as effective as alteplase Reteplase for Thrombolysis in Acute Myocardial Infarction.
Bolus pexelizumab plus infusion appears to be associated with a reduction in mortality up to 6 months in patients with acute myocardial infarction or undergoing coronary artery bypass surgery Effect of Pexelizumab on Mortality in Patients with Acute Myocardial Infarction or Undergoing Coronary Artery Bypass Surgery.

Surgery

In single- or double-vessel disease, off-pump coronary artery bypass (OPCAB) reduces the need for re-intervention for ischaemia, the recurrence of angina and major coronary adverse events at 1 to 5 years compared with percutaneous coronary intervention (PCI) but is associated with an increased length of hospital stay. There appears not to be differences between OPCAB and PCI in death, myocardial infarction, and stroke Off-Pump or Minimally Invasive Coronary Artery Bypass Compared with Percutaneous Coronary Intervention.
Facilitated percutaneous coronary intervention, particularly by thrombolytic therapy, increases mortality, reinfarction, urgent revascularisation and bleeding Facilitated Percutaneous Coronary Intervention (Pci) Vs Pci Alone.

Physiotherapy and rehabilitation

The addition of psychosocial treatments to standard cardiac rehabilitation reduces mortality and morbidity, psychological distress and some biological risk factors Psychosocial Interventions for Patients with Coronary Artery Disease.

Lifestyle and counselling

Fish consumption may decrease the risk of coronary death in high-risk populations, but probably not in low-risk populations Fish Consumption and Coronary Heart Disease Mortality.
Vitamin E and vitamin C are of unknown effectiveness, and beta carotene may be harmful Antioxidants in the Prevention of Cardiovascular Disease.
Current evidence does not seem to support the use of ginseng to treat cardiovascular risk factors, although the evidence is insufficient The Effects of Ginseng on Cardiovascular Risk Factors.

Prevention and screening

Waist-to-hip ratio appears to have a graded and highly significant association with myocardial infarction risk in most ethnic groups worldwide. The use of waist-to-hip ratio instead of BMI appears to improve the risk estimate of myocardial infarction Obesity and Waist-to-Hip-Ratio and Risk of Myocardial Infarction.
Low cardiorespiratory fitness may be a strong and independent predictor of CVD and all-cause mortality and comparable in importance with that of diabetes mellitus and other CVD risk factors Low Cardiorespiratory Fitness and Obesity as Risk Factors for Cardiovascular Diseases.
Self-reported dyspnea at cardiac stress testing appears to be an independent predictor of the risk of death from cardiac or any causes Dyspnea at Cardiac Stress Testing as Predictor of Death.
Exertion-related MIs may occur in habitually inactive people with multiple cardiac risk factors Characteristics of Exertion-Related Acute Myocardial Infarction (MI).

Others

Troponin T and troponin I predict adverse cardiac events in patients with unstable angina pectoris Prognostic Role of Troponin T Versus Troponin I in Unstable Angina Pectoris.
The ACI diagnostic instrument appears to be effective in the diagnosis of cardiac ischaemia. Other technologies that appear effective include the ACI-TIPI, the pre-hospital ECG, the Goldman chest pain protocol, and the ECG exercise test Identifying Acute Cardiac Ischaemia in the Emergency Department.
Prehospital ECG with advanced notification of emergency department (ED) may reduce time to treatment from arrival in the ED Prehospital 12-Lead Electrocardiography with Advanced Notification of Emergency Department in Acute Myocardial Infarction.

Clinical guidelines

Thygesen K, Alpert JS, Jaffe AS et al. Third universal definition of myocardial infarction. Eur Heart J 2012;33(20):2551-67. [PubMed]
Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33(20):2569-619. [PubMed]
Authors/Task Force Members, Hamm CW, Bassand JP et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; First published online: August 26, 2011 [PubMed]
European Association for Percutaneous Cardiovascular Interventions, Wijns W, Kolh P et al. Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2010;31(20):2501-55. [PubMed]
ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: Executive Summary: 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): Circulation 2007;116:803-877.
Antman EM, Anbe DT, Armstrong PW, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004 Aug 3;110(5):588-636. [PubMed]
Antman EM, Hand M, Armstrong PW, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation 2008 Jan 15;117(2):296-329. [PubMed]
Heidbuchel H, Verhamme P, Alings M et al. Updated European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation. Europace 2015;17(10):1467-507. [PubMed]
Heidbuchel H, Verhamme P, Alings M et al. EHRA Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J 2013:Apr 26. [Epub ahead of print] [PubMed]
Heidbuchel H, Verhamme P, Alings M et al. European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace 2013;15(5):625-51. [PubMed]
Lip GY, Huber K, Andreotti F et al. Antithrombotic management of atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing coronary stenting: executive summary--a Consensus Document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association (EHRA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2010;31(11):1311-8. [PubMed]

Literature

White HD, Chew DP. Acute myocardial infarction. Lancet 2008;372(9638):570-84. [PubMed]

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Related resources

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References

Acute Coronary Syndrome and Myocardial Infarction - Related Resources

Cochrane reviews

Drug therapy

Surgery

Lifestyle and counselling

Others

Other evidence summaries

Drug therapy

Surgery

Physiotherapy and rehabilitation

Lifestyle and counselling

Prevention and screening

Others

Clinical guidelines

Literature