Heart attack (myocardial infarction)

Overview

Recognition

A US government patient page lists pain in the chest or upper body, breathlessness, dizziness, sweating and nausea, notes that the symptoms of women often differ, and advises calling 9-1-1 at once if a heart attack is suspected.

Burden

No burden claims are published.

Claims and evidence

No claims are published for this condition yet.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

• Claim, not a settled fact Evaluated for this: Cardiac troponin blood test (Evaluated for, seen from the other side)

  Applies to Recipient not specified

  • People who may be having or recently had a heart attack, and people having surgery that could affect the heart. The page describes testing in the emergency room alongside other heart tests.
  • Hospital emergency room (the page says the test is usually done there).
  • Not stated; the page is written for a US audience.
  • The page does not state an age group.
  • Gestational age Not reported
  • Postnatal age Not reported

  Follow-up Not applicable (patient information page).
  MedlinePlus says a troponin test measures the amount of troponin, a protein found in heart muscle cells, in a blood sample, and that the test is mainly used to help diagnose heart attacks. When heart muscle is damaged, troponin leaks into the blood and the level rises, so results can help confirm heart muscle damage from a heart attack. It adds that higher-than-normal levels are also found in other conditions that damage the heart muscle, so a raised level does not always mean a heart attack. The page says the test is usually done in the emergency room together with other heart tests such as an electrocardiogram, and that a first normal result usually leads to a repeat test within the next 12 hours, because a rise often takes about 2 to 3 hours to show after a heart attack begins.

  Limitations. General patient information from a National Library of Medicine page; it is not an individual care plan and it gives no numeric cut-off. The page does not mention assay generations or high-sensitivity assays by name; it says only that normal levels are so low that only the most sensitive tests can measure them. This claim does not describe any named product.

• Claim, not a settled fact Risk raised by: Coronary artery disease (Associated with a higher risk of, seen from the other side)

  Applies to Adult

  • Adults in general. The pages are written for the public and give no study population, age range or risk group for these statements.
  • General health information for the public; no care setting is stated
  • United States (pages of US government agencies; some figures on them are US statistics)
  • Adults. The NHLBI coronary page gives a prevalence for adults aged 20 and older.

  Follow-up Not applicable (descriptive statement)
  According to NHLBI, coronary artery disease is behind most heart attacks. MedlinePlus describes a heart attack as blood flow to the heart suddenly becoming blocked.

  Limitations. Patient-education pages from two US government sources. They give no study, no size of risk and no population, and they do not say how often coronary artery disease leads to a heart attack beyond the word most.

• Claim, not a settled fact Evaluated for this: Cardiovascular polypill (Evaluated for, seen from the other side)

  Applies to Adult

  • Patients aged 65 or older with a type 1 myocardial infarction in the previous 6 months and at least one further condition from the registry list (diabetes, mild to moderate renal dysfunction, a prior myocardial infarction, prior coronary revascularization, prior stroke, or age 75 or older).
  • Trial sites in seven European countries (registry).
  • Spain, Italy, Germany, France, Hungary, Poland and Czechia (registry countries; the registry description names the Czech Republic).
  • Adults aged 65 or older (registry minimum age 65 years, no maximum)

  Follow-up Median follow-up of 36 months (abstract); the registry plans follow-up of at least 2 years and at most 5 years.
  SECURE was a phase 3, randomized, controlled clinical trial in which patients with a myocardial infarction within the previous 6 months (the registry requires a type 1 infarction, age 65 or older and at least one further risk condition) were assigned to a polypill-based strategy or to usual care. The polypill consisted of aspirin (100 mg), ramipril (2.5, 5, or 10 mg) and atorvastatin (20 or 40 mg). A total of 2499 patients underwent randomization and were followed for a median of 36 months. The primary composite outcome (cardiovascular death, nonfatal type 1 myocardial infarction, nonfatal ischemic stroke, or urgent revascularization) occurred in 118 of 1237 patients (9.5%) in the polypill group and in 156 of 1229 (12.7%) in the usual-care group (hazard ratio 0.76; 95% CI 0.60 to 0.96; P = 0.02). A key secondary outcome (cardiovascular death, nonfatal type 1 myocardial infarction, or nonfatal ischemic stroke) occurred in 101 patients (8.2%) in the polypill group and in 144 (11.7%) in the usual-care group (hazard ratio 0.70; 95% CI 0.54 to 0.90; P = 0.005). The results were consistent across prespecified subgroups. Medication adherence as reported by the patients was higher in the polypill group than in the usual-care group, and adverse events were similar between groups.

  Limitations. The registry lists masking as none, so the trial was open-label as registered. The abstract gives 2499 randomized patients and group denominators of 1237 and 1229; the source does not explain the difference and it is not reconciled here. Adherence was reported by the patients. Patients were aged 65 or older with at least one further risk condition (registry) and a recent type 1 myocardial infarction, at sites in seven European countries. The usual-care arm used drugs and doses chosen by the treating physicians (registry). Only the PubMed abstract and the registry record were read.

Record details

Record id

cardio:myocardial-infarction

Content hash

331e6d1ce2d9f7802f5ec7d82078e5187a023468954f05974adf64ce6dd4624f