Risk assessment in patients with an acute ST-elevation myocardial infarction

Nadeem Ahmed, Jaclyn Carberry, Vannesa Teng, David Carrick, Colin Berry, Nadeem Ahmed, Jaclyn Carberry, Vannesa Teng, David Carrick, Colin Berry

Abstract

ST-elevation myocardial infarction (STEMI) is one of the leading causes of mortality and morbidity worldwide. While the survival after acute STEMI has considerably improved, mortality rate still remains high, especially in high-risk patients. Survival after acute STEMI is influenced by clinical characteristics such as age as well as the presence of comorbidities. However, during emergency care increasing access to tools such as the electrocardiogram, chest x-ray and echocardiography can provide additional information helping to further risk stratify patients. In the invasive setting, this can also include coronary angiography, invasive hemodynamic recordings and angiographic assessments of coronary flow and myocardial perfusion. We outline the common investigations used in STEMI and their role in risk assessment of patients with an acute STEMI.

Keywords: STEMI; cardiac MRI; cardiology/cardiovascular; coronary angiography; echocardiography; evidence-based medicine; invasive hemodynamics; plasma biomarkers; risk assessment; risk scoring.

Conflict of interest statement

Financial & competing interests disclosure

C Berry has collaborated with Siemens Healthcare, UK, but without financial gain. This review was supported by a grant from the British Heart Foundation (PG/11/2/28474). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1. . Routine investigations used in…
Figure 1.. Routine investigations used in ST-elevation myocardial infarction patients in clinical practice.
CFR: Coronary flow reserve; IMH: Intramural hematoma; IMR: Index of microcirculatory resistance; MPO: Myeloperoxidase; MVO: Microvascular obstruction; TIMI: Thrombolysis in myocardial infarction.
Figure 2. . Two patients with acute…
Figure 2.. Two patients with acute ST-elevation myocardial infarction who had cardiac MRI 2 days post-event including T2* mapping.
Angiography in patient A revealed an acutely occluded large obtuse marginal branch (orange arrow). Contrast MRI revealed a lateral infarct with significant microvascular obstruction (orange arrow). This corresponded to an area of intramyocardial hemorrhage as revealed by T2* mapping (black arrow). Patient B suffered an acute occlusion of the mid segment of the right coronary artery (orange arrow). Contrast MRI revealed a small infarct territory (orange arrow) with no intramyocardial hemorrhage visible on the T2* map.

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