Abstract
Ischemic heart disease (IHD) is the leading cause of death and disability worldwide.
An early and accurate diagnosis of IHD is necessary to improve outcomes. According
to recent guidelines, the diagnosis of acute myocardial infarction (AMI) is based
on increased or decreased value of cardiospecific troponins with one measure exceeding
the 99th percentile upper reference limit, associated with symptoms suggestive for
myocardial ischemia, indicative electrocardiogram abnormalities, and evidence of recent
myocardial functional impairment or intracoronary thrombosis. The recent advent of
highly sensitive troponin immunoassays has represented a paradigm shift, wherein the
improved analytical sensitivity has increased the negative predictive value, while
contextually decreasing the diagnostic specificity of these tests. Although several
additional biomarkers have been proposed as surrogate or in combination with troponins,
there is little evidence that any of these will substantially improve AMI diagnosis.
With regard to therapy, early mechanical (i.e., percutaneous coronary intervention,
PCI) or pharmacological reperfusion should be performed early in ST-segment elevation
myocardial infarction (STEMI) within 12 h of symptom onset, whereas fibrinolysis may
be considered in all other circumstances. Patients undergoing primary PCI should also
receive a combination of double antiplatelet therapy (i.e., aspirin and adenosine
diphosphate receptor blocker), associated with parenteral anticoagulation, preferably
with low-molecular-weight heparin. In analogy with STEMI, a wealth of data shows that
primary early invasive strategy (i.e., PCI) and antiplatelet therapy remains the cornerstone
of management of patients with non-ST segment elevation acute coronary syndrome. Stem
cell–based therapy has also emerged as a potentially therapeutic option, and there
are ongoing efforts among several investigators to translate basic research into clinical
practice.
Keywords
acute myocardial infarction - ischemic heart disease - acute coronary syndrome - diagnosis
- therapy
