The Canadian Cardiovascular Society Classification of Acute Atherothrombotic Myocardial Infarction Based on Stages of Tissue Injury Severity: An Expert Consensus Statement.

Autor: Kumar A; Northern Ontario School of Medicine University, and Department of Cardiovascular Sciences, Health Sciences North, Sudbury, Ontario, Canada; Health Sciences North, Sudbury, Ontario, Canada. Electronic address: Andreas.kumar@mac.com., Connelly K; Keenan Research Centre for Biomedical Science, Unity Health Toronto, St Michael's Hospital, University of Toronto, and Department of Physiology, University of Toronto, Toronto, Ontario, Canada., Vora K; Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA., Bainey KR; University of Alberta, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, Canadian VIGOUR Centre, Edmonton, Alberta, Canada., Howarth A; Cardiac Sciences, Faculty of Medicine, University of Calgary, and Libin Cardiovascular Institute, Calgary, Alberta, Canada., Leipsic J; Departments of Radiology and Cardiology, University of British Columbia, Vancouver, British Columbia, Canada., Betteridge-LeBlanc S; Health Sciences North, Sudbury, Ontario, Canada; Northern Ontario School of Medicine University, and Health Sciences North, Sudbury, Ontario, Canada., Prato FS; Lawson Research Institute, University of Western Ontario, London, Ontario, Canada., Leong-Poi H; The Division of Cardiology, St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada., Main A; Northern Ontario School of Medicine University, and Department of Cardiovascular Sciences, Health Sciences North, Sudbury, Ontario, Canada; Health Sciences North, Sudbury, Ontario, Canada., Atoui R; Northern Ontario School of Medicine University, and Department of Surgery, Health Sciences North, Sudbury, Ontario, Canada., Saw J; Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada., Larose E; Department of Medicine, University of Laval, Quebec City, Quebec, Canada., Graham MM; Division of Cardiology, University of Alberta, Faculty of Medicine and Dentistry, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada., Ruel M; University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Dharmakumar R; Krannert Cardiovascular Research Center, Indiana University School of Medicine/IU Health Cardiovascular Institute, Indianapolis, Indiana, USA.
Jazyk: angličtina
Zdroj: The Canadian journal of cardiology [Can J Cardiol] 2024 Jan; Vol. 40 (1), pp. 1-14. Date of Electronic Publication: 2023 Oct 28.
DOI: 10.1016/j.cjca.2023.09.020
Abstrakt: Myocardial infarction (MI) remains a leading cause of morbidity and mortality. In atherothrombotic MI (ST-elevation MI and type 1 non-ST-elevation MI), coronary artery occlusion leads to ischemia. Subsequent cardiomyocyte necrosis evolves over time as a wavefront within the territory at risk. The spectrum of ischemia and reperfusion injury is wide: it can be minimal in aborted MI or myocardial necrosis can be large and complicated by microvascular obstruction and reperfusion hemorrhage. Established risk scores and infarct classifications help with patient management but do not consider tissue injury characteristics. This document outlines the Canadian Cardiovascular Society classification of acute MI. It is an expert consensus formed on the basis of decades of data on atherothrombotic MI with reperfusion therapy. Four stages of progressively worsening myocardial tissue injury are identified: (1) aborted MI (no/minimal myocardial necrosis); (2) MI with significant cardiomyocyte necrosis, but without microvascular injury; (3) cardiomyocyte necrosis and microvascular dysfunction leading to microvascular obstruction (ie, "no-reflow"); and (4) cardiomyocyte and microvascular necrosis leading to reperfusion hemorrhage. Each stage reflects progression of tissue pathology of myocardial ischemia and reperfusion injury from the previous stage. Clinical studies have shown worse remodeling and increase in adverse clinical outcomes with progressive injury. Notably, microvascular injury is of particular importance, with the most severe form (hemorrhagic MI) leading to infarct expansion and risk of mechanical complications. This classification has the potential to stratify risk in MI patients and lay the groundwork for development of new, injury stage-specific and tissue pathology-based therapies for MI.
(Copyright © 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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