- N Engl J Med 2021; 385:2544-2553
In this randomized trial involving patients with out-of-hospital cardiac arrest without ST-segment elevation on postresuscitation electrocardiography, no benefit was found for immediate cardiac catherization as compared with delayed or selective catherization.
- N Engl J Med 2021; 384:452-460
Antithrombotic therapy is a central component of treatment after acute coronary syndromes. The focus is on antiplatelet therapy, but balancing the benefit with the bleeding risk is still controversial. Clinical research and recommended approaches to management are reviewed.
- N Engl J Med 2019; 381:e36
This video presents a practical method for conducting focused cardiac ultrasonography, a qualitative or semiquantitative means of assessing cardiac size, structure, and function at the bedside. The video shows how to perform visual assessment of left ventricular systolic function.
- N Engl J Med 2019; 381:e32
A 60-year-old woman presented to the emergency department with acute chest pain. Initial electrocardiography was suggestive of posterior-wall ischemia. An ECG performed with the use of posterior leads revealed ST-segment elevation in leads V7, V8, and V9, which was consistent with posterior-wall myocardial infarction.
- N Engl J Med 2019; 381:1524-1534
A randomized trial involving patients with acute coronary syndromes showed that prasugrel was superior to ticagrelor with regard to the incidence of death, myocardial infarction, or stroke within 1 year, with no increased risk of bleeding.
- N Engl J Med 2019; 381:1582-1585
Orville Wright said, “If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance.” Approximately one person in the United States has a myocardial infarction every 40 seconds, and more than 1 million coronary events occur each year,...
- N Engl J Med 2019; 380:e41
An 84-year-old man presented with weakness and shortness of breath. Electrocardiographic results aroused concern about an ST-segment elevation myocardial infarction. Imaging of the chest 1 month earlier had revealed a large mass invading the left ventricle.
- N Engl J Med 2019; 380:2146-2155
This review summarizes the pathophysiology and definition of contrast-associated acute kidney injury, as well as risk stratification. The authors discuss controversies regarding the incidence of this condition and highlight studies providing the evidence for preventive care.
- N Engl J Med 2018; 379:1775-1776
Cardiogenic shock occurs in approximately 5% of patients with an acute coronary syndrome — usually, but not always, after ST-segment elevation myocardial infarction. If a large amount of myocardial tissue has become ischemic or injured, pump failure and reduced blood flow to vital organs occur. Urgent percutaneous coronary intervention (PCI)...
- N Engl J Med 2018; 379:1699-1710
In a randomized trial, 706 patients with acute myocardial infarction and cardiogenic shock were assigned to either culprit-lesion-only PCI or immediate multivessel PCI. At 1 year, mortality did not differ significantly between the two groups.
- N Engl J Med 2018; 378:e22
A 36-year-old man presented to the ED with chest discomfort and electrocardiographic changes suggestive of an occlusion of the proximal left anterior descending coronary artery.
- N Engl J Med 2018; 378:960-962
Severe chest pain and dizziness developed in a 44-year-old nurse, the only medical professional at a remote post in Australia. He obtained his own ECG, which showed ST-segment elevation myocardial infarction. With remote instruction, he treated himself with fibrinolysis.
- N Engl J Med 2017; 377:2475-2484
A 41-year-old woman presented with recurrent episodes of chest pain. She had an elevated troponin level, anterior ST-segment depressions on electrocardiography, and focal left ventricular hypokinesis on echocardiography. A diagnosis was made.
- N Engl J Med 2017; 377:2486-2488
Approximately 5 to 10% of cases of acute myocardial infarction are complicated by cardiogenic shock, which is associated with early mortality of 40 to 50%.1 Nearly two decades ago, the SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial established that mortality was lower with emergency...
- N Engl J Med 2017; 377:2419-2432
Among patients who had multivessel coronary disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of death or renal-replacement therapy was lower among those who underwent PCI of the culprit lesion only than among those who underwent multivessel PCI.
- N Engl J Med 2017; 377:1284-1285
Former baseball manager Tony La Russa once said, “Even when you have three strikes, you’re still not out. There is always something else you can do.” This aphorism could apply to cholesteryl ester transfer protein (CETP) inhibitors, a drug class that was designed to reduce the risk of cardiovascular disease...
Is Oxygen Therapy Beneficial in Acute Myocardial Infarction? Simple Question, Complicated Mechanism, Simple AnswerN Engl J Med 2017; 377:1286-1287
Joseph Priestley first reported his discovery of oxygen in 1775 through observations of a candle burning in “dephlogisticated air.” He remarked that the candle burned with great “strength and vivacity” and speculated that this oxygen-enriched air could be used as a medicine; he also expressed concern for its toxic potential,...
- N Engl J Med 2017; 377:1240-1249
In a registry-based randomized clinical trial, 6629 patients with suspected acute myocardial infarction who did not have hypoxemia were assigned to either supplemental oxygen or ambient air. Supplemental oxygen did not reduce all-cause mortality at 1 year.
- N Engl J Med 2017; 377:1217-1227
In this trial involving patients with atherosclerotic disease who were receiving effective statin therapy, those who were assigned to receive anacetrapib, a CETP inhibitor, had a lower risk of major coronary events than did those in the placebo group.
- N Engl J Med 2017; 377:1198-1200
The prognosis for patients with ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) is improved with the use of percutaneous coronary intervention (PCI). Choosing the best procedural anticoagulation regimen to balance the risks of ischemia and bleeding during PCI is essential to optimize outcomes. Heparin, a nonspecific indirect thrombin inhibitor,...