• Cardiovascular

    When a Heart Attack Isn’t a Heart Attack; All Heart Attacks are not Equal

Graphic of stethoscope
All heart attacks are not equal

A heart attack typically occurs unexpectedly, it often causes chest pain, and it is diagnosed by recording the electrical activity of the heart (electrocardiogram) and by measurement of a heart muscle protein in the blood (troponin or CK-MB). All doctors agree that this kind of “heart attack” negatively impacts patients’ lives and they all agree how to diagnosis and treat these patients.

There is another kind of heart attack, that may occur as a complication of coronary angioplasty and coronary bypass surgery (procedures used to open clogged coronary arteries). Until recently, patients were labeled to have a heart attack after these procedures if they have a miniscule rise in the blood levels of a heart muscle protein (troponin) without any known effect on their prognosis. As a result, many patients stayed longer in the hospital than was necessary, and occasionally underwent repeat imaging tests and other procedures.

“If you tell a patient, ‘You have had a heart attack,’ it should mean something about prognosis and clinical outcomes, not only an abnormal blood test,” says Issam Moussa, M.D., FSCAI, chair of the Division of Cardiovascular Diseases at Mayo Clinic Florida in Jacksonville, who was part of a panel established by The Society for Cardiovascular Angiography and Interventions (SCAI) tasked with finding a better way to diagnose post-angioplasty heart attacks to improve patient care and quality outcomes.  The panel’s consensus document is e-published today in Catheterization and Cardiovascular Interventions (CCI) and Journal of the American College of Cardiology (JACC).

Journalists: Sound bites with Dr. Moussa are available in the downloads.

“Our recommendations for a new definition of heart attack would better identify those patients with true complications after angioplasty or bypass surgery that require urgent action, better reflect the quality of these procedures and inform future research designed to identify the best preventive strategies,” Dr. Moussa says.

“We believe this new criteria will very likely reduce hospital stay after angioplasty and reduce unnecessary testing and repeat procedures, and will not affect patients in any adverse way.”