The Canadian Cardiovascular Society (CCS) released the world’s first classification of acute myocardial infarction (AMI), or heart attack, based on heart tissue damage research which was driven by two cardiovascular investigators within the Ischemic Heart Disease Program of Krannert Cardiovascular Research Center (KCVRC) at Northern Ontario School of Medicine and Indiana University School of Medicine.
Recently In Canada, the four-stage classification, CCS-AMI, was presented at the Vascular 2023 conference and was published in the Canadian Journal of Cardiology. With more than two decades of experience in myocardial infarction research, PhD and immediate past Chief of Cardiology and physician scientist Andreas Kumar, MD from Northern Ontario School of Medicine and KCVRC Executive Director Rohan Dharmakumar conceptualized the classification.
Working together with the CCS-AMI Writing Group, which comprised of an expert panel of cardiovascular specialists primarily from Canada and KCVRC physician scientist Keyur Vora, MD, FACC, the group developed the framework and rationale for the CCS-AMI Classification. The CCS-AMI Writing Group was recognized by the CCS, chaired by Kumar and co-chaired by Dharmakumar and Michelle Graham, MD, president of CCS.
Clinical classifications are studied and developed by medical societies to introduce and implement new standards of care and evolving guidelines. Knowing what level of tissue damage has happened on the heart muscle can help cardiologists to find out how to redirect care to prevent a patient case from escalating, even with present treatments.
In cardiovascular care, CCS classifications have a rich history. CCS-AMI classification arrives nearly 50 years after the founding of the CCS-Angina classification in 1972, which is used widely around the world to measure chest pain. Unlike CCS-Angina, which is based on clinical parameters, CCS-AMI uses a hybrid of clinical data and pathophysiology of heart muscle damage to characterize the level of injury following AMI.
Authors of the consensus paper say a classification that contains tissue-level changes is needed to leverage the predictive power of tissue damage to advance research and develop tissue-directed therapies for each stage.
The CCS-AMI Classification outlines damage to the heart muscle following a heart attack in four progressively severe stages based on decades of research:
CCS Stage 1 Myocardial Infarction: Terminated Myocardial Infarction
CCS Stage 2 Myocardial Infarction: Cardiomyocyte necrosis without microvascular damage
CCS Stage 3 Myocardial Infarction: Microvascular obstruction and Cardiomyocyte necrosis.
CCS Stage 4 Acute Myocardial Infarction: reperfusion hemorrhage, microvascular obstruction and Cardiomyocyte necrosis
The last two stages are directly connected with reperfusion injury and extensive tissue damage. This classification creates the crucial framework needed, so new therapies can be made to maximize impact on patient outcomes.
Rohan Dharmakumar, PhD, KCVRC Executive Director mentioned that the classification is a game-changing tool which opens new paths for patient risk assessment and future drug development in an easy, usable format.
He also added that, not all heart attacks are the same, patient risk therapies will improve when the exact stage of tissue injury is considered.
