Myocardial infarction (MI) treatment in 773 Cardiac surgery clinics worldwide

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773 clinics specializing in Cardiac surgery providing treatment of Myocardial infarction (MI) Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow to a part of the heart is blocked, leading to the death of heart muscle tissue. It is a medical emergency and requires immediate treatment to restore blood flow and prevent further damage.
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disease worldwide.

Africa · 8
Americas · 191
Asia · 256
Europe · 285
Oceania · 33
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Africa · 8 Americas · 191 Asia · 256 Europe · 285 Oceania · 33
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Prices for popular procedures:
  1. Redo heart surgery
    ≈ $5,908
  2. Off-pump coronary artery bypass
    ≈ $10,092
  3. Cardiac catheterization
    ≈ $1,008
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  5. Temporary pacemaker implantation
    ≈ $536
  6. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  7. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  8. Dual chamber pacemaker insertion
    ≈ $4,655
  9. Coronary artery bypass graft (CABG)
    ≈ $8,740
photo
Lajeado, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Bruno Born Hospital is a philanthropic institution, with more than 80 years. It is registered with the National, State and Municipal Councils of Social Assistance read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $5,908
  2. Off-pump coronary artery bypass
    ≈ $10,092
  3. Cardiac catheterization
    ≈ $1,008
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  5. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  6. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  7. Coronary artery bypass graft (CABG)
    ≈ $8,740
  8. Radiofrequency ablation (RFA)
    ≈ $6,898
  9. Percutaneous ASD closure
    ≈ $4,305
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​ Hospital São Camilo Pompeia has followed, over the years, the growth of the population and the scientific and technological advances aimed at medical and read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $5,908
  2. Off-pump coronary artery bypass
    ≈ $10,092
  3. Cardiac catheterization
    ≈ $1,008
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  5. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  6. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  7. Coronary artery bypass graft (CABG)
    ≈ $8,740
  8. Radiofrequency ablation (RFA)
    ≈ $6,898
  9. Percutaneous ASD closure
    ≈ $4,305
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
Integrated into the São Camilo de São Paulo Hospitals Network in March 1979, the Santana Unit has an agile and modern structure implemented to offer read more
Prices for popular procedures:
  1. Cardiac catheterization
    ≈ $1,008
  2. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  3. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  4. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  5. Radiofrequency ablation (RFA)
    ≈ $6,898
  6. Percutaneous ASD closure
    ≈ $4,305
  7. Percutaneous closure of ventricular septal defect (VSD)
    ≈ $5,352
  8. Coronary catheterization
    ≈ $1,003
  9. Catheter cardiac ablation
    ≈ $3,620
photo
São Paulo, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
A member of the Network since 2000, Hospital São Camilo Ipiranga has an emergency room for patients aged 12 years and over, an Intensive Care read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $5,908
  2. Off-pump coronary artery bypass
    ≈ $10,092
  3. Cardiac catheterization
    ≈ $1,008
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  5. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  6. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  7. Coronary artery bypass graft (CABG)
    ≈ $8,740
  8. Heart valve replacement
    ≈ $8,834
  9. Heart valve repair
    ≈ $9,355
photo
Rio de Janeiro, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Quinta D'Or Hospital opened in September 2001 and is located opposite Quinta da Boa Vista, in Rio de Janeiro. It emerged from the renovation read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $5,908
  2. Off-pump coronary artery bypass
    ≈ $10,092
  3. Cardiac catheterization
    ≈ $1,008
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  5. Temporary pacemaker implantation
    ≈ $536
  6. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  7. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  8. Dual chamber pacemaker insertion
    ≈ $4,655
  9. Coronary artery bypass graft (CABG)
    ≈ $8,740
photo
Belo Horizonte, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Lifecenter Hospital stands out among the most sophisticated and renowned health institutions in Minas Gerais. Its activities cover urgent and emergency medical care, surgeries, read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $5,908
  2. Off-pump coronary artery bypass
    ≈ $10,092
  3. Cardiac catheterization
    ≈ $1,008
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $1,408
  5. Temporary pacemaker implantation
    ≈ $536
  6. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $4,231
  7. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $3,942
  8. Dual chamber pacemaker insertion
    ≈ $4,655
  9. Coronary artery bypass graft (CABG)
    ≈ $8,740
photo
Serra, Brazil
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Founded in 2001, Vitória Apart Hospital is a center of excellence in high complexity medicine in Espírito Santo, prepared to take care of people's health read more
Prices for popular procedures:
  1. Temporary pacemaker implantation
    ≈ $739
  2. Dual chamber pacemaker insertion
    ≈ $6,735
  3. Fontan procedure
    ≈ $18,235
  4. Permanent pacemaker implantation
    ≈ $7,623
  5. Radiofrequency ablation (RFA)
    ≈ $15,064
  6. Catheter cardiac ablation
    ≈ $9,658
  7. Patent ductus arteriosus (PDA) ligation in children
    ≈ $10,442
  8. Single chamber pacemaker insertion
    ≈ $7,520
  9. Cardiac resynchronization therapy with pacemaker (CRT-P)
    ≈ $10,888
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Ricardo Gutiérrez Children's Hospital is a highly complex, tertiary, reference hospital for the entire country and neighboring countries. Since its creation, in 1875, it read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Cardiac catheterization
    ≈ $2,042
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $2,022
  5. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $5,791
  6. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $7,029
  7. Coronary artery bypass graft (CABG)
    ≈ $17,315
  8. Fontan procedure
    ≈ $18,235
  9. Percutaneous ASD closure
    ≈ $9,250
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Hospital "Prof. Dr. Juan P. Garrahan" is the pediatric center of reference in public health, free and highly complex in Argentina. Since its inauguration, read more
Prices for popular procedures:
  1. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $5,791
  2. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $7,029
  3. Heart valve replacement
    ≈ $24,885
  4. Heart valve repair
    ≈ $21,634
  5. Aortic valve replacement (AVR)
    ≈ $23,180
  6. Mitral valve replacement (MVR)
    ≈ $18,325
  7. Transcatheter aortic valve replacement (TAVR)
    ≈ $32,318
  8. Coronary catheterization
    ≈ $1,511
  9. Mechanical valve replacement
    ≈ $29,549
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Orthopedic surgery, Oncology
On July 24, 1896, the Pirovano Hospital (which was to be called Belgrano Hospital) opened its doors to ensure the assistance of an original population read more
Prices for popular procedures:
  1. Cardiac catheterization
    ≈ $2,042
  2. Intraaortic balloon pump (IABP) procedure
    ≈ $2,022
  3. Temporary pacemaker implantation
    ≈ $739
  4. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $5,791
  5. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $7,029
  6. Dual chamber pacemaker insertion
    ≈ $6,735
  7. Permanent pacemaker implantation
    ≈ $7,623
  8. Percutaneous ASD closure
    ≈ $9,250
  9. Percutaneous closure of ventricular septal defect (VSD)
    ≈ $9,238
photo
Posadas, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Orthopedic surgery, Oncology
The Health Park of the Province of Misiones "Dr. Ramón Madariaga" was created through Law XVII Nº70, approved by the majority of the legislative body read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Temporary pacemaker implantation
    ≈ $739
  4. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $5,791
  5. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $7,029
  6. Dual chamber pacemaker insertion
    ≈ $6,735
  7. Coronary artery bypass graft (CABG)
    ≈ $17,315
  8. Heart valve replacement
    ≈ $24,885
  9. Heart valve repair
    ≈ $21,634
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Orthopedic surgery
Inaugurated on March 1, 1991, the Suizo Argentina Clinic and Maternity began its history with a revolutionary vision in the concept of care and comfort read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $5,791
  4. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $7,029
  5. Coronary artery bypass graft (CABG)
    ≈ $17,315
  6. Fractional flow reserve (FFR)
    ≈ $767
  7. Rotational atherectomy
    ≈ $1,863
  8. Heart transplantation
    ≈ $39,764
  9. Pulmonary artery thromboendarterectomy
    ≈ $8,352
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Neurosurgery, Orthopedic surgery, Oncology
The Revista del Hospital El Cruce (ISSN: 2524-9932), in its abbreviated name Rev Hosp El Cruce, is a scientific and continuous periodical publication of the read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Coronary artery bypass graft (CABG)
    ≈ $17,315
  4. Radiofrequency ablation (RFA)
    ≈ $15,064
  5. Catheter cardiac ablation
    ≈ $9,658
  6. Electrophysiology study (EPS)
    ≈ $2,721
  7. Alcohol septal ablation in hypertrophic obstructive cardiomyopathy
    ≈ $5,210
  8. Coarctectomy in children
    ≈ $11,417
  9. Pulmonary artery thromboendarterectomy
    ≈ $8,352
photo
Rosario, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
More than 100 years ago, on June 24, 1912, the Spanish Hospital was inaugurated in Rosario, driven by the demand for health care from Spanish read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Temporary pacemaker implantation
    ≈ $739
  4. Dual chamber pacemaker insertion
    ≈ $6,735
  5. Coronary artery bypass graft (CABG)
    ≈ $17,315
  6. Heart valve replacement
    ≈ $24,885
  7. Heart valve repair
    ≈ $21,634
  8. Aortic valve replacement (AVR)
    ≈ $23,180
  9. Mitral valve replacement (MVR)
    ≈ $18,325
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
The Pueyrredon Private Clinic was born in response to the need of Mar del Plata doctors who worked at that time as professionals in mutual read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Cardiac catheterization
    ≈ $2,042
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $2,022
  5. Temporary pacemaker implantation
    ≈ $739
  6. Percutaneous coronary intervention (PCI) with angioplasty
    ≈ $5,791
  7. Percutaneous coronary intervention (PCI) with stent insertion
    ≈ $7,029
  8. Dual chamber pacemaker insertion
    ≈ $6,735
  9. Coronary artery bypass graft (CABG)
    ≈ $17,315
photo
Córdoba, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Spine surgery, Orthopedic surgery, Oncology
We are a benchmark health care network in Argentina and we are committed to offering the world excellent medicine. Our Hospital is among the main read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Coronary artery bypass graft (CABG)
    ≈ $17,315
  4. Septal myectomy
    ≈ $10,960
  5. Repair of the ruptured sinuses of Valsalva
    ≈ $14,812
  6. Atrial septal defect (ASD) repair
    ≈ $12,437
  7. Ventricular septal defect (VSD) repair
    ≈ $14,503
  8. Heart tumor surgery
    ≈ $10,855
  9. Open-heart intracardiac foreign body removal
    ≈ $13,015
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Thoracic surgery, Neurosurgery, Spine surgery, Oncology
The “Ángel H. Roffo” Institute of Oncology is a high-complexity referral center at the national level, dedicated to the multidisciplinary care of adult cancer patients. read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Temporary pacemaker implantation
    ≈ $739
  4. Dual chamber pacemaker insertion
    ≈ $6,735
  5. Coronary artery bypass graft (CABG)
    ≈ $17,315
  6. Heart valve replacement
    ≈ $24,885
  7. Heart valve repair
    ≈ $21,634
  8. Aortic valve replacement (AVR)
    ≈ $23,180
  9. Mitral valve replacement (MVR)
    ≈ $18,325
photo
Córdoba, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Instituto Modelo de Cardiologia Privado SRL (IMC) is a professional organization focused on the Vision and Mission of: Offer patients comprehensive personalized medical assistance, read more
Prices for popular procedures:
  1. Cardiac catheterization
    ≈ $2,042
  2. Intraaortic balloon pump (IABP) procedure
    ≈ $2,022
  3. Temporary pacemaker implantation
    ≈ $739
  4. Dual chamber pacemaker insertion
    ≈ $6,735
  5. Permanent pacemaker implantation
    ≈ $7,623
  6. Percutaneous ASD closure
    ≈ $9,250
  7. Percutaneous closure of ventricular septal defect (VSD)
    ≈ $9,238
  8. Single chamber pacemaker insertion
    ≈ $7,520
  9. Cardiac resynchronization therapy with pacemaker (CRT-P)
    ≈ $10,888
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Thoracic surgery, Orthopedic surgery, Oncology
As of March 14, 1994, the Alexander Fleming Institute opened its doors to medical and scientific excellence. Maximum technical-scientific level and comfort in one of read more
Prices for popular procedures:
  1. Redo heart surgery
    ≈ $19,938
  2. Off-pump coronary artery bypass
    ≈ $16,921
  3. Cardiac catheterization
    ≈ $2,042
  4. Intraaortic balloon pump (IABP) procedure
    ≈ $2,022
  5. Temporary pacemaker implantation
    ≈ $739
  6. Dual chamber pacemaker insertion
    ≈ $6,735
  7. Coronary artery bypass graft (CABG)
    ≈ $17,315
  8. Heart valve replacement
    ≈ $24,885
  9. Heart valve repair
    ≈ $21,634
photo
San Fernando del Valle de Catamarca, Argentina
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Neurosurgery, Orthopedic surgery, Oncology
Sanatorio Junín offer the entire population of Catamarca and the NOA integrated health care at levels of low to high complexity, with a highly qualified read more

Clinics grouping by rating

Clinic with the highest rating of 5 — Clinical Hospital Lapino in Moscow, Russia and 5 more, clinic with the most reviews number of 35612 — Aster CMI hospital in Bengaluru, India.

With rating 4.0 and over — 282 clinics .

Countries with the highest number of clinics treating the diseases:

Myocardial infarction (MI):

Related procedures:

Myocardial infarction (MI) - what is the disease?

Myocardial infarction - etiology, pathogenesis

Acute myocardial infarction (MI) is one of the most common diagnoses in hospitalized patients in industrialized countries. MI occurs as a result of an acute lack of oxygen due to a violation of its delivery to the heart muscle (myocardium), resulting in the death of heart tissue. This process is characterized by certain causes and mechanisms, the understanding of which is important for maintaining health.

What is the difference between ST-elevation and non-ST-elevation MI?

The ST segment is a specific area on a patient's ECG. Identification of its rise is very important for further management of the patient. Incomplete restriction of blood flow to the site of the heart characterizes unstable angina, which can lead to non-ST elevation myocardial infarction (NSTEMI). Complete and sudden occlusion (narrowing) of a coronary artery is usually associated with ST-segment elevation myocardial infarction (STEMI).

What is the difference between unstable angina and NSTEMI?

In NSTEMI, due to damage and destruction of heart cells, the level of troponins (molecules that are released from the heart muscle when it is damaged) in the blood is increased, while in unstable angina, the concentration of these markers is normal.

What is acute coronary syndrome (ACS) and how is it related to myocardial infarction?

Symptoms of MI of different types are also similar to those of angina pectoris. Without a blood test and an ECG, it will be difficult for the medical team to make an accurate diagnosis, therefore, until a specific pathology (for example, ST-segment elevation myocardial infarction) is identified, the patient's condition is referred to as acute coronary syndrome.

What is the cause (etiology) of MI?

Depending on the cause of MI, 5 types of this pathology are distinguished:

  1. MI as a result of rupture or erosion of atherosclerotic plaques; with the formation of a blood clot or hemorrhage into the plaque.
  2. MI due to a mismatch between oxygen supply and demand for it; without the destruction of plaques and the formation of blood clots (for example, with severe anemia or respiratory failure).
  3. Sudden unexpected cardiac death that occurs before troponin levels can be measured. In this type, a person has recent changes in the ECG or MI is detected at autopsy.
  4. Heart attack associated with percutaneous coronary intervention (subtype 4a), stent thrombosis (subtype 4b), or restenosis (recurrent blockage) in a coronary artery where a stent was previously placed.
  5. MI associated with coronary artery bypass surgery.

ACS develops most often as a result of the formation of a thrombus on a damaged atherosclerotic plaque (type I myocardial infarction), which reduces the patency of the coronary artery and, accordingly, disrupts blood flow. This leads to an imbalance between the heart muscle's oxygen demand and oxygen supply. Ischemia and damage to cardiomyocytes occur.

The following factors also increase the risk of developing myocardial infarction:

  • diabetes;
  • smoking;
  • hypertension;
  • high level of cholesterol;
  • hyperlipidemia;
  • passive lifestyle;
  • diet high in fat;
  • stress;
  • metabolic syndrome;
  • family history of ischemic heart disease (including MI and sudden cardiac death);
  • the presence of first-degree relatives who underwent coronary revascularization;
  • age;
  • belonging to the male sex;
  • obesity.

Thus, some patients with MI may have a large number of risk factors at the same time. Less common conditions that predispose people to a heart attack are:

  • hypercoagulability (a change that leads to increased thrombus formation);
  • disease of collagen vessels;
  • abuse of cocaine;
  • intracardiac thrombi or masses that can cause blockage of the coronary arteries.

Can acute myocardial infarction occur after chest and heart injury?

Myocardial infarction is an uncommon complication in patients with chest trauma. Due to the latter, damage to the vessels of the heart can occur. This leads to MI due to coronary spasm, thrombosis, rupture or dissection of the arterial wall. Patients with underlying coronary artery disease are more susceptible to ACS in trauma as a result of limited coronary reserve, excess circulating catecholamines (eg, adrenaline), hypoxia (oxygen starvation), blood loss, and decreased blood pressure.

More commonly, the patient may experience cardiogenic syncope (fainting) due to an arrhythmia due to trauma, which also often leads to an increase in the level of markers specific for MI (troponin) without significant coronary artery stenosis. This requires the doctor to correctly interpret laboratory tests in such a patient.

Is pregnancy a risk factor for MI?

As the age of the pregnant woman increases, the risk of acute myocardial infarction increases (especially for women older than 45-50 years). In addition to other factors, pregnancy increases the risk of a heart attack by 3 to 4 times. The frequency of MI during pregnancy ranges from 3 to 100 per 100,000 births. Maternal mortality reaches 11%, and the associated fetal mortality is 9%.

Pathogenesis of myocardial infarction with ST segment elevation

This type of MI usually occurs with a sharp decrease in coronary blood flow after thrombotic occlusion of a coronary artery previously affected by atherosclerosis. Slowly developing stenosis (narrowing) of the coronary arteries of a high degree usually does not provoke ST-segment elevation MI. This is due to the fact that over time, a collateral network of vessels is formed that feeds the heart.

A STEMI occurs when a blood clot in a coronary artery develops rapidly at the site of an injury to the vessel. In most cases, with the destruction of an atherosclerotic plaque and the appearance of conditions (local or systemic) that promote thrombosis, a parietal thrombus forms at the site of plaque rupture and the affected coronary artery becomes blocked.

Histological studies (studies of heart tissue) show that coronary plaques, prone to destruction, have a rich lipid core and a thin fibrous membrane. After the initial layer of platelets is formed at the site of the destroyed plaque, various triggers (collagen, ADP, adrenaline, serotonin) contribute to their activation.

After stimulation of platelets, thromboxane A2 is released, a strong local vasoconstrictor (vasoconstrictor) agent, further activation of platelets occurs and potential resistance to fibrinolysis (destruction of a blood clot) develops.

In addition to the formation of thromboxane A2, platelet activation promotes changes in glycoprotein IIb/IIIa receptors, which are converted and develop a high affinity for soluble adhesive (binding) proteins such as fibrinogen. The latter can simultaneously bind to two different platelets, which leads to compaction and platelet aggregation.

Also, with the development of MI, the so-called coagulation cascade is formed. It is activated after damage to arterial cells at the site of plaque rupture. As a result of this cascade, the coronary vessel is eventually blocked by a thrombus containing platelet aggregates and fibrin strands.

In rare cases, STEMI may be precipitated by coronary artery occlusion caused by coronary embolism, congenital anomalies, coronary spasm, or a wide range of systemic, especially inflammatory, diseases.

Pathogenesis of STEMI

NSTEMI is most commonly caused by an imbalance between oxygen supply and demand, which results from partial occlusion of a vessel by a thrombus. This thrombus is formed on the destroyed atherosclerotic coronary plaque or due to erosion of the endothelium of the coronary arteries.

Other causes of non-ST elevation myocardial infarction include:

  1. Severe mechanical obstruction (blockage of the vessel) due to progressive coronary atherosclerosis.
  2. Dynamic obstruction (for example, coronary spasm, as in Prinzmetal's variant angina).
  3. Increased myocardial oxygen demand (for example, with an increase in heart rate, provoked by an increase in body temperature).

More than one of these processes may be involved.

Statistically, in NSTEMI, approximately 10% of patients have left main coronary artery stenosis, 35% have three-vessel disease, 20% have two-vessel disease, 20% have single-vessel occlusion, and 15% have no overt coronary artery stenosis.

Patients with NSTEMI often have several atherosclerotic plaques that are at risk of destruction (so-called vulnerable plaques).

What determines the degree of damage to the heart muscle?

The amount of myocardial damage caused by coronary occlusion depends on:

  1. the volume of tissue supplied by the affected vessel;
  2. the degree of blockage of the vessel (full or partial occlusion) and its duration;
  3. the volume of blood supplied through the collateral vessels to the affected tissue;
  4. myocardial oxygen demand;
  5. internal (endogenous) factors that can cause early spontaneous lysis (destruction) of an occlusive thrombus;
  6. the adequacy of myocardial blood supply in the infarction zone when blood flow is restored.

Thus, myocardial infarction can have a different etiology. The disease is characterized by risks that are similar to those of other diseases of the heart and blood vessels (for example, smoking or obesity). Incomplete restriction of blood flow to the heart can lead to non-ST elevation myocardial infarction (NSTEMI). Complete and sudden occlusion of a coronary artery is usually associated with ST-segment elevation myocardial infarction (STEMI).

References:

  1. Glenn N. Levine. Cardiology Secrets, 5th Edition. 2018. ISBN-13: 978-0323478700.
  2. Netter’s cardiology, third edition. 2019. ISBN: 978-0-323-54726-0.
  3. Harrison`s Principles of Internal Medicine 19/E (Vol.1). Dennis Kasper, Anthony Fauci, Stephen Hauseret all. McGraw-HillEducation 2015 ISBN: 0071802134 ISBN-13(EAN): 9780071802130.
  4. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177.
  5. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2021;42(23):2298.