ST elevation myocardial infarction: Difference between revisions

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Overview
Pathophysiology
Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology
Histopathology
Causes
Differentiating ST elevation myocardial infarction from other Diseases
Epidemiology and Demographics
Risk Factors
Triggers
Natural History and Complications
Risk Stratification and Prognosis
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Pre-Hospital Care
Initial Care Oxygen Nitrates Analgesics Aspirin Beta Blockers Antithrombins The coronary care unit The step down unit STEMI and Out-of-Hospital Cardiac Arrest Pharmacologic Reperfusion Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) Fibrinolysis Reperfusion at a Non–PCI-Capable Hospital:Recommendations Mechanical Reperfusion The importance of reducing Door-to-Balloon times Primary PCI Adjunctive and Rescue PCI Rescue PCI Facilitated PCI Adjunctive PCI CABG Management of Patients Who Were Not Reperfused Assessing Success of Reperfusion Antithrombin Therapy Antithrombin therapy Unfractionated heparin Low Molecular Weight Heparinoid Therapy Direct Thrombin Inhibitor Therapy Factor Xa Inhibition DVT prophylaxis Long term anticoagulation Antiplatelet Agents Aspirin Thienopyridine Therapy Glycoprotein IIbIIIa Inhibition Other Initial Therapy Inhibition of the Renin-Angiotensin-Aldosterone System Magnesium Therapy Glucose Control Calcium Channel Blocker Therapy Lipid Management
Pre-Discharge Care
Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT
Post Hospitalization Plan of Care
Long-Term Medical Therapy and Secondary Prevention Overview Inhibition of the Renin-Angiotensin-Aldosterone System Cardiac Rehabilitation Pacemaker Implantation Long Term Anticoagulation Implantable Cardioverter Defibrillator ICD implantation within 40 days of myocardial infarction ICD within 90 days of revascularization
Case Studies
Case #1
Case #2
Case #3
Case #4
Case #5
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VisualWikitext

Latest revision as of 00:15, 30 July 2020

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Arzu Kalayci, M.D. [2]

Synonyms and keywords: AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis

Classification

Anterior myocardial infarction | Inferior myocardial infarction | Right ventricular myocardial infarction | Posterior myocardial infarction | Lateral myocardial infarction

Pathophysiology

Pathophysiology of Vessel Occlusion | Pathophysiology of Reperfusion | Gross Pathology | Histopathology

Differentiating ST Elevation Myocardial Infarction from other Diseases

Natural History and Complications

Risk Stratification and Prognosis

Diagnosis

Treatment

Initial Care

Pharmacologic Reperfusion | Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) | Fibrinolysis

Antiplatelet Agents | Aspirin | Thienopyridine Therapy | Glycoprotein IIbIIIa Inhibition

Long-Term Medical Therapy and Secondary Prevention

Case Studies

Case #1 | Case #2 | Case #3 | Case #4 | Case #5

Disclaimer

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here.

Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
-'''For patient information click [[{{PAGENAME}} (patient information)|here]] {{SI}}'''.'''For patient information click [[{{PAGENAME}} (patient information)|here]] {{SI}}'''{{Infobox_Disease |
+__NOTOC__
-  Name           = Myocardial infarction|
+{| class="infobox" style="float:right;"
-  DiseasesDB     = 8664 |
+|-
-  ICD10          = {{ICD10|I|21||i|20}}-{{ICD10|I|22||i|20}} |
+| [[File:Siren.gif|30px|link=STEMI resident survival guide]]|| <br> || <br>
-  ICD9           = {{ICD9|410}} |
+| [[STEMI resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
-  ICDO           = |
+|}
-  OMIM           = |
+{{ST elevation myocardial infarction}}
-  MedlinePlus    = 000195 |
-  eMedicineSubj  = med |
-  eMedicineTopic = 1567 |
-  eMedicine_mult = {{eMedicine2|emerg|327}} {{eMedicine2|ped|2520}} |
-  MeshID         = |
-}}
-__NOEDITSECTION__
-{{SI}}
-'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
-{{WikiDoc Cardiology Network Infobox}}
-{{CMG}}
+'''For patient information click [[Heart attack (patient information)|here]]'''
-In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme used by the ACC / AHA guidelines. [[ACC AHA Guidelines Classification Scheme|Read more about the classification scheme used by the ACC / AHA Guidelines Committee here]].
+{{CMG}} {{AKK}}
-----
-'''''Keywords and synonyms:''''' <small>AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis </small>
-==Overview==
+{{SK}} AMI, STEMI, heart attack, MI, myocardial infarct, acute MI, coronary, coronary thrombosis
-===[[ST Elevation Myocardial Infarction Overview|Overview]]===
+== [[ST elevation myocardial infarction overview|Overview]] ==
-===[[ST Elevation Myocardial Infarction: Epidemiology and Demographics | Epidemiology and Demographics]]===
+== [[ST elevation myocardial infarction classification|Classification]] ==
+[[Anterior myocardial infarction]] | [[Inferior myocardial infarction]] | [[Right ventricular myocardial infarction]] | [[Posterior myocardial infarction]] | [[Lateral myocardial infarction]]
+== [[ST elevation myocardial infarction pathophysiology|Pathophysiology]] ==
-==Pathophysiology==
+[[ST elevation myocardial infarction pathophysiology|Pathophysiology of Vessel Occlusion]] | [[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion|Pathophysiology of Reperfusion]] |  [[ST elevation myocardial infarction gross pathology|Gross Pathology]] | [[ST elevation myocardial infarction histopathology|Histopathology]]
-===[[ST Elevation Myocardial Infarction Risk Factors|Risk Factors]]===
+== [[ST elevation myocardial infarction causes|Causes]] ==
-===[[ST Elevation Myocardial Infarction Triggers|Triggers]]===
+== [[ST elevation myocardial infarction differential diagnosis|Differentiating ST Elevation Myocardial Infarction from other Diseases]] ==
-===[[ST Elevation Myocardial Infarction Pathophysiology|Pathophysiology of Vessel Occlusion]]===
+== [[ST elevation myocardial infarction epidemiology and demographics|Epidemiology and Demographics]] ==
-===[[ST Elevation Myocardial Infarction: Pathophysiology of Reperfusion |Pathophysiology of Reperfusion]]===
+== [[ST elevation myocardial infarction risk factors|Risk Factors]] ==
+== [[ST elevation myocardial infarction triggers|Triggers]] ==
-==Diagnosis==
+== [[ST elevation myocardial infarction natural history and complications|Natural History and Complications]] ==
-===[[ST Elevation Myocardial Infarction Diagnosis|Diagnosis, classification and biomarkers]]===
+==[[ST elevation myocardial infarction risk stratification and prognosis|Risk Stratification and Prognosis]]==
-===[[ST Elevation Myocardial Infarction Symptoms|Symptoms]]===
+==[[ST elevation myocardial infarction in pregnancy|STEMI in Pregnancy]]==
-===[[Chest pain|Differential diagnosis of chest pain]]===
+== Diagnosis ==
-===[[ST Elevation Myocardial Infarction Physical Examination|Physical Examination]]===
+[[ST elevation myocardial infarction diagnostic criteria|Diagnostic Criteria]] | [[ST elevation myocardial infarction history and symptoms|History and Symptoms]] | [[ST elevation myocardial infarction physical examination|Physical Examination]] | [[ST elevation myocardial infarction laboratory findings|Laboratory Findings]] | [[ST elevation myocardial infarction electrocardiogram|Electrocardiogram]] | [[ST elevation myocardial infarction EKG examples|EKG Examples]] | [[ST elevation myocardial infarction chest x ray|Chest X Ray]] | [[ST elevation myocardial infarction cardiac MRI|Cardiac MRI]] | [[ST elevation myocardial infarction echocardiography|Echocardiography]] | [[ST elevation myocardial infarction coronary angiography|Coronary Angiography]]
-===[[ST Elevation Myocardial Infarction Electrocardiogram|Electrocardiogram]]===
+== Treatment ==
-===[[ST Elevation Myocardial Infarction Coronary Angiography|Coronary Angiography]]===
+=== [[ST elevation myocardial infarction pre-hospital care|Pre-Hospital Care]] ===
-===[[ST Elevation Myocardial Infarction Gross Pathology|Gross Pathology]]===
+=== [[ST elevation myocardial infarction initial care|Initial Care]] ===
-===[[ST Elevation Myocardial Infarction Histopathology|Histopathology]]===
+[[ST elevation myocardial infarction oxygen therapy|Oxygen]] | [[ST elevation myocardial infarction nitrate therapy|Nitrates]] | [[ST elevation myocardial infarction analgesic therapy|Analgesics]] | [[ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[ST elevation myocardial infarction beta blocker therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] |  [[Step Down Unit|The step down unit]] | [[STEMI and Out-of-Hospital Cardiac Arrest]]
-==Treatment==
+'''Pharmacologic Reperfusion''' | [[ST elevation myocardial infarction reperfusion therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST elevation myocardial infarction fibrinolytic therapy|Fibrinolysis]]
-===[[ST Elevation Myocardial Infarction Pre-Hospital Care|Pre-Hospital Care]]===
+'''Mechanical Reperfusion''' | [[Door-to-Balloon|The importance of reducing Door-to-Balloon times]] | [[ST elevation myocardial infarction primary percutaneous coronary intervention|Primary PCI]] | [[ST elevation myocardial infarction percutaneous coronary intervention following fibrinolytic administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]]  |
+[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |
+[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |
+[[ST elevation myocardial infarction coronary artery bypass grafting|CABG]] | [[ST elevation myocardial infarction management of patients who were not reperfused|Management of Patients Who Were Not Reperfused]] | [[ST elevation myocardial infarction assessing success of reperfusion|Assessing Success of Reperfusion]]
-===[[ST Elevation Myocardial Infarction Initial Care|Initial Care]]===
+'''Antithrombin Therapy''' | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]]  | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin|Low Molecular Weight Heparinoid Therapy]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin|Direct Thrombin Inhibitor Therapy]] |  [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]] | [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|DVT prophylaxis]] |  [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|Long term anticoagulation]]
-[[ST Elevation Myocardial Infarction Oxygen Therapy|Oxygen]] | [[ST Elevation Myocardial Infarction Nitrate Therapy|Nitrates]] | [[ST Elevation Myocardial Infarction Analgesic Therapy|Analgesics]] | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Beta Blocker Therapy|Beta Blockers]] | [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombins]] | [[Coronary care unit|The coronary care unit]] |  [[Step Down Unit|The step down unit]]
+'''Antiplatelet Agents''' | [[ST elevation myocardial infarction aspirin therapy|Aspirin]] | [[ST elevation myocardial infarction thienopyridine therapy|Thienopyridine Therapy]] | [[ST elevation myocardial infarction glycoprotein IIbIIIa inhibition|Glycoprotein IIbIIIa Inhibition]]
-'''Pharmacologic Reperfusion''' | [[ST Elevation Myocardial Infarction Reperfusion Therapy|Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)]] | [[ST Elevation Myocardial Infarction Fibrinolytic Therapy|Fibrinolysis]]
+'''Other Initial Therapy'''  |  [[ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST elevation myocardial infarction magnesium therapy|Magnesium Therapy]] |  [[ST elevation myocardial infarction glucose control|Glucose Control]] | [[ST elevation myocardial infarction calcium channel blocker therapy|Calcium Channel Blocker Therapy]] | [[ST elevation myocardial infarction lipid management|Lipid Management]]
-'''Mechanical Reperfusion''' | [[Door-to-Balloon| The importance of reducing Door-to-Balloon times]] | [[ST Elevation Myocardial Infarction Primary Percutaneous Coronary Intervention|Primary PCI]] | [[ST Elevation Myocardial Infarction Percutaneous Coronary Intervention Following Fibrinolytic Administration|Adjunctive and Rescue PCI]] | [[ST elevation myocardial infarction rescue percutaneous coronary intervention|Rescue PCI]]  |
+=== [[ST elevation myocardial infarction discharge care|Pre-Discharge Care]] ===
-[[ST elevation myocardial infarction facilitated percutaneous coronary intervention|Facilitated PCI]] |
-[[ST Elevation Myocardial Infarction Adjunctive Percutaneous Coronary Intervention|Adjunctive PCI]] |
-[[ST Elevation Myocardial Infarction Coronary Artery Bypass Grafting|CABG]] | [[ST Elevation Myocardial Infarction Management of Patients Who Were Not Reperfused|Management of Patients Who Were Not Reperfused]] | [[ST Elevation Myocardial Infarction Assessing Success of Reperfusion|Assessing Success of Reperfusion]]
-'''Antithrombin Therapy'''  • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy|Antithrombin therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Unfractionated Heparin|Unfractionated heparin]]  • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Enoxaparin| Low Molecular Weight Heparinoid Therapy]] • [[ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Bivalirudin| Direct Thrombin Inhibitor Therapy]] •  [[ ST elevation myocardial infarction anticoagulant and antithrombotic therapy#Fondaparinux|Factor Xa Inhibition]]
+==Long-Term Medical Therapy and Secondary Prevention ==
+[[ST elevation myocardial infarction secondary prevention|Overview]] | [[ST elevation myocardial infarction inhibition of the renin-angiotensin-aldosterone system at discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]]  |
+[[ST elevation myocardial infarction cardiac rehabilitation|Cardiac Rehabilitation]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]] | [[ST elevation myocardial infarction deep vein thrombosis prophylaxis and anticoagulation|Long Term Anticoagulation]] | [[ST elevation myocardial infarction implantable cardioverter defibrillator|Implantable Cardioverter Defibrillator]]
-'''Antiplatelet Agents''' | [[ST Elevation Myocardial Infarction Aspirin Therapy|Aspirin]] | [[ST Elevation Myocardial Infarction Thienopyridine Therapy|Thienopyridine Therapy]] | [[ST Elevation Myocardial Infarction Glycoprotein IIbIIIa Inhibition|Glycoprotein IIbIIIa Inhibition]]
+==Case Studies==
+[[ST elevation myocardial infarction case study one|Case #1]] | [[ST elevation myocardial infarction case study two|Case #2]] | [[ST elevation myocardial infarction case study three|Case #3]] | [[ST elevation myocardial infarction case study four|Case #4]] | [[ST elevation myocardial infarction case study five|Case #5]]
-'''Other Initial Therapy'''  |  [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System|Inhibition of the Renin-Angiotensin-Aldosterone System]] | [[ST Elevation Myocardial Infarction Magnesium Therapy|Magnesium Therapy]] |  [[ST Elevation Myocardial Infarction Glucose Control|Glucose Control]] | [[ST Elevation Myocardial Infarction Calcium Channel Blocker Therapy|Calcium Channel Blocker Therapy]]
+== Disclaimer ==
-==Discharge Care==
-[[ST Elevation Myocardial Infarction Secondary Prevention|Secondary Prevention]] | [[ST Elevation Myocardial Infarction Inhibition of the Renin-Angiotensin-Aldosterone System at Discharge|Inhibition of the Renin-Angiotensin-Aldosterone System]]  |
-[[ST Elevation Myocardial Infarction Cardiac Rehabilitation|Cardiac Rehabilitation]] | [[ST Elevation Myocardial Infarction Prognosis|Prognosis]] | [[ST elevation myocardial infarction pacemaker implantation|Pacemaker Implantation]]
-==Complications==
-===[[ST Elevation Myocardial Infarction Complications|Overview]]===
-'''Ischemic Complications:''' [[Reinfarction]]
-'''Mechanical Complications:'''[[Cardiogenic shock]]   |   [[Left ventricular aneurysm]]   |   [[Myocardial rupture]]   |   [[Left ventricular aneurysm|Pseudoaneurysm]]   |   [[Papillary muscle rupture]]   |
-[[Rupture of the ventricular septum]]
-'''Arrhythmic Complications:'''   [[Sudden cardiac death]]
-'''Embolic Complications:'''   [[Stroke]]
-'''Pericarditis:'''  [[Post myocardial infarction pericarditis]]   |   [[Dressler's syndrome]]
-==See also==
-* [[The Living Guidelines: STEMI]]
-==Disclaimer==
 Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the [[wikidoc:General disclaimer|disclaimers]] page for important information regarding limitations of the information found here.
-==External links==
+[[es:Infarto agudo de miocardio]]
+[[fr:Infarctus du myocarde]]
-* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
+[[tr:Akut miyokard enfarktüsünün klinik sınıflaması]]
-* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to date resource of Cardiovascular Research]
-* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study from the United States National Heart, Lung and Blood Institute]
-* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack overview from MedlinePlus]
-* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada]
-* [http://www.regionalpci-stemi.org/index.html A Regional PCI and Resource Center for STEMI]
-* [http://www.stemisystems.org/ STEMI Systems' Quarterly newsletter]
-* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
-* [http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site]
 {{STEMI}}
+{{Circulatory system pathology}}
-[[ar:احتشاء قلبي]]
+{{WikiDoc Help Menu}}
-[[bg:Инфаркт на миокарда]]
+{{WikiDoc Sources}}
-[[cs:Infarkt myokardu]]
-[[de:Myokardinfarkt]]
-[[et:Müokardi infarkt]]
-[[es:Infarto agudo de miocardio]]
-[[eu:Miokardio infartu akutu]]
-[[fr:Infarctus du myocarde]]
-[[ko:심근경색]]
-[[hr:Infarkt miokarda]]
-[[id:Serangan jantung]]
-[[it:Infarto del miocardio]]
-[[he:התקף לב]]
-[[ku:Mirina masûlkeyên dil]]
-[[la:Infarctus cordis]]
-[[mk:Срцев напад]]
-[[ms:Sakit jantung]]
-[[nl:Hartaanval]]
-[[ja:心筋梗塞]]
-[[no:Hjerteinfarkt]]
-[[pl:Zawał mięśnia sercowego]]
-[[pt:Infarto agudo do miocárdio]]
-[[ru:Острый инфаркт миокарда]]
-[[sq:Infarkti miokardial]]
-[[sr:Срчани удар]]
-[[fi:Sydäninfarkti]]
-[[sv:Hjärtinfarkt]]
-[[ur:احتشاء عضل قلب]]
-[[vi:Nhồi máu cơ tim]]
-[[tr:Miyokardiyal enfarktüs]]
-[[uk:Гострий інфаркт міокарду]]
-[[yi:הארץ אטאקע]]
-[[zh:心肌梗死]]
+[[Category:Disease]]
 [[Category:Cardiology]]
+[[Category:Ischemic heart diseases]]
 [[Category:Intensive care medicine]]
 [[Category:Emergency medicine]]
+[[Category:Up-To-Date]]
-{{keywords|acute MI|heart attack|\bSTEMI|fibrinolysis|door to balloon|rescue PCI|facilitated PCI|myocardial infarct|coronary thrombosis}}
+[[Category:Up-To-Date cardiology]]
+[[Category:Mature chapter]]
-{{WikiDoc Help Menu}}
-{{WikiDoc Sources}}

v t e ST Elevation Myocardial Infarction
Background	Overview • Epidemiology and Demographics • Classification
Risk factors and Triggers	Risk Factors • Triggers
Pathophysiology	Pathophysiology of Vessel Occlusion • Pathophysiology of Reperfusion• Gross Pathology • Histopathology
Diagnosis	Diagnosis • Symptoms • Differential Diagnosis of Chest Pain • Physical Examination • Electrocardiogram • Right ventricular myocardial infarction • Atrial Infarction • Cardiac Markers • Coronary Angiography
Treatment	Pre-Hospital Care Pre-Hospital Care Initial Care Initial Care • Oxygen • Nitrates • Analgesics • Aspirin • Beta Blockers Pharmacologic Reperfusion • Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) • Fibrinolysis Mechanical Reperfusion • The Importance of Reducing Door-to-Balloon Times • Primary PCI • Adjunctive and Rescue PCI • Rescue PCI • Facilitated PCI • Adjunctive PCI • CABG • Management of Patients Who Were Not Reperfused • Assessing Success of Reperfusion Antithrombin Therapy • Antithrombin therapy • Unfractionated heparin • Low Molecular Weight Heparinoid Therapy • Direct Thrombin Inhibitor Therapy • Factor Xa Inhibition Antiplatelet Agents • Aspirin • Thienopyridine Therapy • Glycoprotein IIbIIIa Inhibition Inhibition of the Renin-Angiotensin-Aldosterone System • Inhibition of the Renin-Angiotensin-Aldosterone System Other Adjunctive Therapies • Magnesium Therapy • Glucose Control • Calcium Channel Blocker Therapy
Monitoring	Arrhythmia Monitoring
Complications	Complications
Discharge Care	Secondary Prevention • Cardiac Rehabilitation • Prognosis