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Myocardial infarction is the main cause of death in Western societies (1).
Myocardial infarction is considered as part of a spectrum referred to as acute
coronary syndrome, which refers to a range of acute myocardial ischaemia that
also includes unstable angina and non-ST segment elevation myocardial infarction
- the criteria for diagnosing myocardial infarction are detection of rise
and/or fall of cardiac biomarkers (preferably troponin) with at least one
value above the 99th percentile of the upper reference limit, together with
evidence of myocardial ischaemia with at least one of the following (2)
- symptoms of ischaemia
- electrocardiogram (ECG) changes indicative of new ischaemia (new ST-T
changes or new left bundle branch block (LBBB))
- development of pathological Q wave changes in the ECG
- imaging evidence of new loss of viable myocardium or new regional wall
A myocardial infarction that has associated ST elevation is defined as a
STEMI (ST segment elevation myocardial infarction). Before the use of the
term acute coronary syndrome (and use of more sensitive cardiac markers such
as troponin), this was what was previously diagnosed as a myocardial infarction.
About 30% of people who die of a myocardial infarction do so before reaching
A study investigating one-year mortality following diagnosis of acute coronary syndrome showed (1):
- mortality rate was 3.9% within one year of discharge
- independent mortality predictors identified (in order of predictive strength):
- age, lower ejection fraction, poorer EQ-5D quality of life, elevated serum creatinine, in-hospital cardiac complications, chronic obstructive pulmonary disease, elevated blood glucose, male gender, no PCI/CABG after NSTEMI, low hemoglobin, peripheral artery disease, on diuretics at discharge
A study investigating two-year mortality following diagnosis of acute coronary syndrome showed (2):
- mortality rate was 5.5% within two years of discharge
- independent mortality predictors identified were:
- age, low ejection fraction, no coronary revascularization/thrombolysis, elevated serum creatinine, poor EQ-5D score, low haemoglobin, previous cardiac or chronic obstructive pulmonary disease, elevated blood glucose, on diuretics or an aldosterone inhibitor at discharge, male sex, low educational level, in-hospital cardiac complications, low body mass index, ST-segment elevation myocardial infarction diagnosis, and Killip class
Data from a large Swedish registry including 108 315 post-MI patients with long-term follow-up revealed a cumulative rate of a cardiovascular composite endpoint (cardiovascular death, recurrent MI, and stroke) of 18.3% in the first year after MI, 9.0% in the subsequent year and 20.0% in the following 3 years (7)
Myocardial infarction accounts for one third of the mortality which can be
attributed to coronary artery disease. Atheromatous coronary artery disease
is almost always the cause of myocardial infarction.
- (1) NICE (May 2007). Secondary
prevention in primary and secondary care for patients following a myocardial
- (2) NICE (March 2010).
Assessment and diagnosis of recent onset chest pain or discomfort of suspected
- (3) NICE (July 2013). Myocardial
infarction with STsegment elevation - The acute management of myocardial infarction
with ST-segment elevation
- (4) British Heart Foundation Factfile (2006).Delays in Treatment for Acute
- (5) Pocock S, Bueno H, Licour M, Medina J, Zhang L, Annemans L, Danchin N, Huo Y, Van de Werf F. Eur Heart J Acute Cardiovasc Care. 2015 Dec; 4(6):509-17. Epub 2014 Oct 9.
- (6) Pocock SJ et al.Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score.Eur Heart J Acute Cardiovasc Care. 2019 Dec; 8(8):727-737. Epub 2017 Aug 4.
- (7) Jernberg T, Hasvold P, Henriksson M, Hjelm H, Thuresson M, Janzon M. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J. 2015;36:1163-1170
Last edited 12/2020 and last reviewed 12/2020