Acute myocardial infarction without ST-segment elevation: an expanded view
Infarto agudo do miocárdio sem supra desnivelamento do seguimento ST: uma visão ampliada
Palavras-chave:
Door-to-balloon time, Myocardial Revascularization, Risk StratificationResumo
This study, part of a narrative review, explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and therapeutic management of Acute Myocardial Infarction without ST-Segment Elevation (NSTEMI), a critical condition within the spectrum of cardiovascular diseases (CVDs). CVDs are the leading causes of global mortality, with NSTEMI significantly contributing to morbidity and mortality. The pathogenesis of NSTEMI involves the rupture of atherosclerotic plaques and subsequent thrombogenesis, leading to myocardial necrosis. Modifiable risk factors, such as diabetes mellitus and smoking, are crucial in prevention and management. Diagnosis relies on electrocardiography and biomarkers, while treatment is based on medical interventions and revascularization procedures, guided by risk scores such as TIMI and GRACE. Risk stratification is crucial for optimizing clinical outcomes, allowing for a personalized approach and aiming to reduce associated mortality.
Downloads
Referências
AMSTERDAM, Ezra A. et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Journal Of The American College Of Cardiology, [S.L.], v. 64, n. 24, p. 139-228, dez. 2014. Elsevier BV. http://dx.doi.org/10.1016/j.jacc.2014.09.017. Disponível em: https://www.sciencedirect.com/science/article/pii/S0735109714062792?via%3Dihub. Acesso em: 03 set. 2023.
ANDERSON, H.V et al. ACC/AHA Key Data Elements and Definitions for Chest Pain and Acute Myocardial Infarction. Journal Of The American College Of Cardiology, [S.L.], v. 80, n. 17, p. 1660-1700, out. 2022. Elsevier BV. http://dx.doi.org/10.1016/j.jacc.2022.05.012.Disponível em: https://www.jacc.org/doi/10.1016/j.jacc.2022.05.012. Acesso em: 02 set. 2023.
ANTMAN, Elliott M. et al. The TIMI Risk Score for Unstable Angina/Non–ST Elevation MI. Jama, [S.L.], v. 284, n. 7, p. 835, 16 ago. 2020. American Medical Association (AMA). http://dx.doi.org/10.1001/jama.284.7.835. Disponível em: https://jamanetwork.com/journals/jama/fullarticle/192996. Acesso em: 02 set. 2023.
BRASIL. Ministério da Saúde. DATASUS (Departamento de Informática do SUS). Brasília, DF; 2023. Disponível em: http://tabnet.dive.sc.gov.br. Acesso em: 02 set. 2023.
BRASIL. Ministério da Saúde. Datasus. Informações em saúde. Estatísticas Vitais, Mortalidade. Brasília, DF; 2018. Disponível em:http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/obt10br. Acesso em: 03 set.2023.
CANTARELLI, Marcelo J. de Carvalho et al. Intervenção Coronária Percutânea em Pacientes Jovens. Revista Brasileira de Cardiologia Invasiva, [S.L.], v. 22, n. 4, p. 353-358, dez. 2014. FapUNIFESP (SciELO). http://dx.doi.org/10.1590/0104-1843000000059. Disponível em: https://www.scielo.br/j/rbci/a/sntM49Nm4Bnfz9PzHHqwQrH/?lang=pt#. Acesso em: 03 set. 2023.
COLLET, Jean-Philippe et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal, [S.L.], v. 42, n. 14, p. 1289-1367, 29 ago. 2020. Oxford University Press (OUP). http://dx.doi.org/10.1093/eurheartj/ehaa575. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32860058/. Acesso em: 02 set. 2023.
FOX, Kaa et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the british heart foundation rita 3 randomised trial. The Lancet, [S.L.], v. 360, n. 9335, p. 743-751, set. 2002. Elsevier BV. http://dx.doi.org/10.1016/s0140-6736(02)09894-x. Disponível em: https://pubmed.ncbi.nlm.nih.gov/12241831/. Acesso em: 24 set. 2023.
GRANGER, Christopher B.. Predictors of Hospital Mortality in the Global Registry of Acute Coronary Events. Archives Of Internal Medicine, [S.L.], v. 163, n. 19, p. 2345, 27 out. 2021. American Medical Association (AMA). http://dx.doi.org/10.1001/archinte.163.19.2345. Disponível em: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/216232. Acesso em: 03 set. 2023.
GRUNDY, Scott M. et al.2018AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/
APhA/ASPC/NLA/PCNAGuideline on the Management of Blood Cholesterol: executive summary. Journal Of The American College Of Cardiology, [S.L.], v. 73, n. 24, p. 3168-3209, jun. 2019. Elsevier BV.
http://dx.doi.org/10.1016/j.jacc.2018.11.002. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30423391/. Acesso em: 03 set. 2023.
HAIDER, Ahmed et al. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. European Heart Journal, [S.L.], v. 41, n. 13, p. 1328-1336, 26 dez. 2019. Oxford University Press (OUP). http://dx.doi.org/10.1093/eurheartj/ehz898. Disponível em: https://academic.oup.com/eurheartj/article/41/13/1328/5687217. Acesso em: 03 set. 2023.
JAMESON, J. Larry et al. Medicina Interna de Harrison. 20. ed. Porto Alegre: Amgh Editora Ltda, 2020.
KOFOED, Klaus F. et al. Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome. Circulation, [S.L.], v. 138, n. 24, p. 2741-2750, 11 dez. 2018. Ovid Technologies (Wolters Kluwer Health). http://dx.doi.org/10.1161/circulationaha.118.037152. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30565996/. Acesso em: 24 set. 2023.
MAHLER, Simon A. et al. The HEART Pathway RandomizedTrial. Circulation:Cardiovascular Quality and Outcomes, [S.L.], v. 8, n. 2, p. 195-203,mar. 2015. Ovid Technologies (Wolters Kluwer Health).http://dx.doi.org/10.1161/circoutcomes.114.001384. Disponível em:https://pubmed.ncbi.nlm.nih.gov/25737484/. Acesso em: 03 set. 2023.
MORAES, D. S. et al. Fatores associados à internação prolongada nas admissões pela urgência e emergência. Revista da Universidade Vale do Rio Verde, Três Corações, v. 15, n. 2, p. 680-691, ago./dez. 2017. Disponível em: http://periodicos.unincor.br/index.php/revistaunincor/article/view/3770/pdf_730.Acesso em: 03 set. 2023.
NICOLAU, José Carlos et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST – 2021. Arquivos Brasileiros de Cardiologia, [S.L.], v. 117, n. 1, p. 181-264, jul. 2021. Sociedade Brasileira de Cardiologia. http://dx.doi.org/10.36660/abc.20210180. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294740/#S01. Acesso em: 02 set. 2023.
OLIVEIRA, Cátia Costa et al. Diferenças entre os Sexos no Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST – Análise Retrospectiva de um Único Centro. Arquivos Brasileiros de Cardiologia, [S.L.], v. 120, n. 1, p. 1-10, 2023. Sociedade Brasileira de Cardiologia. http://dx.doi.org/10.36660/abc.20211040. Acesso em: 03 set. 2023.
OMS – Organização Mundial da Saúde. Doenças cardiovasculares (DCV). Genebra, 2021.Disponível em:https://www.who.int/newsroom/factsheets/detail/cardiovascular-diseases-(cvds). Acesso em: 30 ago. 2023.
PHILIP, J. Podrid. UpToDate. Uptodate.com. Disponível em: <https://www.uptodate.com/contents/ventricular-arrhythmias-during-acute-myocardial-infarction-incidence-mechanisms-and-clinical-features?search=COMPLICA%C3%87%C3%95ES%20DO%20IAMSSST&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2>. Acesso em: 4 set. 2023.
REYENTOVICH, Alex & THIELE, Holger. UpToDate. Uptodate.com. Disponível em: <https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-cardiogenic-shock-in-acute-myocardial-infarction?search=complica%C3%A7%C3%B5es%20cardiogenica%20ap%C3%B3s%20infato%20agudo%20do%20miocardio&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2>. Acesso em: 4 set. 2023.
ROTH, Gregory A. et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019. Journal Of The American College Of Cardiology, [S.L.], v. 76, n. 25, p. 2982-3021, dez. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.jacc.2020.11.010. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755038/. Acesso em: 02 set. 2023.
SAKAMOTO, Jeffrey Tadashi et al. Comparing HEART, TIMI, and GRACE scores for prediction of 30-day major adverse cardiac events in high acuity chest pain patients in the emergency department. International Journal Of Cardiology, [S.L.], v. 221, p. 759-764, out. 2016. Elsevier BV. http://dx.doi.org/10.1016/j.ijcard.2016.07.147. Disponível em: https://pubmed.ncbi.nlm.nih.gov/27428317/. Acesso em: 03 set. 2023.
THIELE, Holgen & ABBOTT, J. Dawn. UpToDate. Uptodate.com. Disponível em: <https://www.uptodate.com/contents/acute-myocardial-infarction-mechanical-complications?search=COMPLICA%C3%87%C3%95ES%20DO%20IAMSSST&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Acesso em: 4 set. 2023.