A document published in the Canadian Journal of Cardiology outlines the Canadian Cardiovascular Society's classification of acute MI.
By Dr. Liji Thomas, MDNov 1 2023Reviewed by Danielle Ellis, B.Sc. Myocardial infarction causes millions of deaths worldwide. Though there have been advances in the survival rates following ST-elevation MI , survivors often develop heart failure due to ischemic cardiomyopathy. Diagnostic standards and risk scores are thus of importance in improving patient management in this area.
These do not consider the myocardial damage that causes cardiac remodeling, especially of the ventricles. Thus, they do not predict sequelae like heart failure, arrhythmias, or hospitalization, nor mortality from prior MI. This shows the need for newer tools incorporating tissue damage. Based on these findings obtained by advanced imaging techniques including Cardiovascular Magnetic Resonance imaging, the ischemia/reperfusion injury cascade has been described, showing four sequential stages through which myocardial damage occurs in reperfused myocardium.
This indicates the crucial need to begin early reperfusion treatment before ischemia is prolonged, thus maximizing the potential for almost complete prevention of necrosis. Tissue-level perfusion is best assessed by myocardial contrast echocardiography and CMR, whereas epicardial coronary artery flow is assessed on coronary angiography.
CCS stage 2 In CCS stage 2, complete salvage is no longer possible, and myocardial necrosis has occurred to a significant degree. However, the vascular bed remains intact, with normal tissue perfusion after the epicardial block is resolved. Following stage 2, infarct size increases, and regional wall motion abnormality is visible on echocardiography.CCS stage 3 CCS stage 3 includes the earliest stage of reperfusion injury, with the injury extending beyond the epicardial layer.
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