Abstract
The primary objective of this study was to conduct a bibliometric analysis of the most influential papers on ST-Elevation Myocardial Infarction (STEMI). Using the Scopus database (October 2024), a targeted search was performed to identify relevant publications. Three retrieval options were considered based on the appearance of search terms. Precisely those documents were analyzed where the search terms appeared only in the title, allowing for a focused analysis of the most directly relevant studies. Next, from this search, the top 100 most cited papers, spanning from 1981 to 2018, were selected for detailed examination. Data analysis was conducted using VOSviewer and R Studio to provide insights into publication trends, author productivity, and the thematic focus of STEMI research. Author performance was evaluated through various bibliometric indicators, including total publications (TP), total citations (TC), h-index, g-index, m-index, HG composite, and Q2 index. Key metrics such as mean total citations per article (MeanTCperArt) and mean annual citation rate (MeanTCperYear) were also calculated. Thematic analysis of research topics was conducted using unigrams, bigrams, and trigrams, highlighting primary areas of focus across the most impactful STEMI studies. The results underscore significant trends in STEMI research, with highly cited papers shaping the field’s evolution. This bibliometric approach provides valuable insights into research patterns, major contributors, and prevalent themes within STEMI literature.
Introduction
Myocardial infarction (MI), is a critical medical condition that arises when blood flow to a segment of the heart muscle is obstructed for a duration sufficient to cause damage or death of the myocardial tissue. This interruption in blood supply is often due to a blockage in the coronary arteries, primarily caused by atherosclerosis, which involves the buildup of plaque—fatty deposits within the arterial walls. Myocardial infarction poses serious health risks, including heart failure, arrhythmias, and sudden cardiac death, making its understanding essential for both prevention and treatment.
MI are primarily categorized into two main groups: ST-Elevation Myocardial Infarction (STEMI) and Non-ST-Elevation Myocardial Infarction (NSTEMI). STEMI is characterized by a significant elevation in the ST segment on an electrocardiogram (ECG), indicating a full-thickness (transmural) infarction of the heart muscle. This condition typically results from the rupture of an atherosclerotic plaque, leading to the complete occlusion of a coronary artery and a rapid loss of blood supply. Patients experiencing STEMI often present with severe chest pain that may radiate to the left arm, jaw, or back, accompanied by other symptoms such as sweating, nausea, or shortness of breath. Immediate diagnosis is confirmed through ECG findings and elevated cardiac biomarkers, with treatment strategies often involving reperfusion therapies like percutaneous coronary intervention (PCI) or thrombolytics to restore blood flow to the affected area. ,
In contrast, NSTEMI does not exhibit ST segment elevation on the ECG, although it may show other changes such as ST segment depression or T-wave inversions. This type of myocardial infarction is usually the result of plaque rupture leading to a partial occlusion of the coronary artery, which may resolve spontaneously while still causing myocardial injury. Patients with NSTEMI may present with chest pain that is often less intense than in STEMI, along with symptoms like fatigue, indigestion, and shortness of breath. Diagnosis relies on cardiac biomarker levels, ECG changes, and sometimes imaging studies. Treatment typically involves medications, including antiplatelet agents, beta-blockers, and statins, with PCI reserved for higher-risk patients.
Furthermore, MI can be classified based on the underlying mechanisms into specific categories recognized by the American College of Cardiology and the American Heart Association. Type 1 MI refers to spontaneous myocardial infarction due to a primary coronary event, such as plaque rupture leading to thrombosis. Type 2 MI occurs when there is an imbalance between oxygen supply and demand, such as in cases of severe anemia or coronary vasospasm. Type 3 MI refers to death due to suspected myocardial ischemia, which occurs before biomarker measurements can be obtained. Types 4 and 5 MI relate to procedural events, specifically those occurring during percutaneous coronary interventions or coronary artery bypass grafting, respectively.
It is noteworthy to acknowledge the existing gap in bibliometric reports about STEMI. To the best of our knowledge, there are limited comprehensive analyses in this critical domain. Our research group has considerable experience in bibliometric analysis, marked by a series of various cardiovascular topics. Some of the examples include comprehensive analysis of Multimodality Imaging for Complex Congenital Heart Disease, Cardiorenal Syndrome, Heart Transplantation, Ventricular Remodeling, Cardio-Oncology, Statin utilization, and Familial Hypercholesterolemia.
The main objective of the present study is to perform a bibliometric analysis of STEMI, aiming to contribute valuable insights to the existing body of knowledge. By shedding light on the current state of research and identifying key trends, our study may aspire to pave the way for further advancements in understanding and managing this critical cardiovascular condition.
Material and method
A comprehensive bibliometric analysis was conducted (In Oct 2024) using the Scopus database, a leading source for peer-reviewed literature across various disciplines. The search was designed to capture relevant literature on ST Elevation Myocardial Infarction (STEMI) without restricting the time frame, allowing for a thorough investigation of the existing body of work. The following search terms were employed for data retrieval from the Scopus database:
“ST Elevation Myocardial Infarction” or “ST Elevation MI” or “Acute ST Elevation Myocardial Infarction” or “Acute Myocardial Infarction” or “Acute Heart Attack” or “Transmural Myocardial Ischemia” or “ST Elevation Acute Coronary Syndrome” or “ST Segment Elevation Myocardial Infarction” or “STEMI” or “Acute ST Elevation MI” or “ST Segment Elevation MI” or “Acute MI” or “ST Elevation ACS”. This extensive list ensured that a broad spectrum of relevant literature was included in the analysis.
To ensure a focused selection of relevant literature, three options were considered for retrieving documents based on the presence of the specified search terms. The first option allowed for the inclusion of documents containing the search terms in the title, abstract, or keywords. The second option narrowed the search to documents where the search terms appeared only in the abstract. The third option focused solely on documents that included the search terms in the title. For this study, Option 3 was selected, which provided several advantages. By limiting the search to titles, the documents retrieved were highly relevant to the topic, as titles generally reflect the core subject of the study. This approach also enhanced the precision of the search, minimizing the inclusion of unrelated studies that may contain the terms in the abstract or keywords but do not directly pertain to STEMI. Moreover, this strategy reduced the volume of retrieved documents, resulting in a more manageable dataset for subsequent analysis.
Following the selection process, the top 100 most cited papers were analyzed to assess their contributions to the field of STEMI research. This analysis aimed to identify trends, key authors, influential institutions, and significant findings within the literature. To facilitate this process, the selected documents were downloaded in CSV format from the Scopus database. The data were then analyzed using two software tools: VOSviewer and R Studio. VOSviewer enabled the visualization of bibliometric networks, allowing for the exploration of co-authorship, keyword co-occurrence, and citation analysis. Concurrently, R Studio, utilizing the bibliometrix package, provided in-depth statistical analysis that offered insights into publication trends, citation metrics, and author contributions.
Through this systematic approach, the study effectively mapped the landscape of STEMI research, highlighting significant contributions and emerging trends in the literature. This methodology not only underscored the importance of a focused search strategy but also demonstrated the utility of bibliometric tools in synthesizing vast amounts of scientific information.
Results and discussion
The effect of search strategy
The choice of search strategy significantly influenced the total number of results retrieved from the Scopus database. Analyzing the impact of different options for including search terms in the document selection process reveals a marked difference in the quantity of relevant literature. When using the most inclusive strategy, which involved retrieving documents where the search terms appeared in the title, abstract, or keywords, a total of 110,938 results was obtained. This approach captured a broad spectrum of literature, ensuring that numerous relevant studies were included in the dataset. In contrast, when the search was narrowed to include documents only with the search terms in the abstract, the number of results decreased to 84,678 . This reduction highlights how restricting the search to abstracts still yielded a substantial amount of relevant literature, but at a significant loss of available documents that could have contributed to a more comprehensive understanding of the topic. Finally, when focusing solely on documents that contained the search terms in the title, the total number of results further decreased to 50,445 . This strategy, while ensuring that only the most directly relevant documents were included, illustrates a considerable reduction in the overall volume of literature available for analysis.
In summary, the change in strategy from a broad inclusion of titles, abstracts, and keywords to a more selective approach focusing solely on titles resulted in a dramatic alteration in the total number of results, underscoring the importance of search parameters in bibliometric studies. The significant reduction in the number of results from 110,938 to 50,445 emphasizes the need for careful consideration of search strategies in order to balance comprehensiveness with relevance in literature retrieval.
The top authors, universities, countries, sources and sponsors
The analysis of the literature on ST Elevation Myocardial Infarction (STEMI) revealed key contributions from prominent authors, institutions, countries, funding sponsors, and journals, illustrating the landscape of research in this critical area. Among the most prolific authors in the field, Jeong, M.H. led with 382 publications. Following closely, Stone, G.W. contributed 302 publications, and Krumholz, H.M. produced 285 publications. This demonstrates the significant output of these individuals in advancing knowledge in STEMI research.
The analysis identified the top affiliations contributing to STEMI research. Harvard Medical School was the most prolific institution, with 833 publications. It was closely followed by Brigham and Women’s Hospital, which contributed 828 publications, and the Duke Clinical Research Institute, with 715 publications. These institutions play a crucial role in shaping the research agenda in cardiovascular health. A geographic analysis revealed that the United States leads in STEMI research with a total of 11,483 publications. China followed with 6,086, while Japan contributed 3,480 publications. Italy also made significant contributions, with 3,064 publications. This data underscores the dominance of the United States in STEMI research while highlighting the contributions from other nations. The financial backing for STEMI research comes from various organizations, with the National Heart, Lung, and Blood Institute being the top sponsor, supporting 1,236 publications. The National Natural Science Foundation of China followed closely with 1,144 funded studies, and the National Institutes of Health contributed to 1,102 publications. This funding landscape is essential for sustaining research initiatives in this critical area of cardiovascular health.
The most significant journals publishing research on STEMI included the American Journal of Cardiology, which published 2,872 articles, followed by the International Journal of Cardiology with 1,517 articles, and the American Heart Journal, which contributed 1,413 articles. These journals are pivotal in disseminating important findings related to STEMI.
In summary, the results highlight the influential authors, key institutions, prominent countries, vital funding sources, and leading journals in the field of STEMI research, illustrating a dynamic and collaborative landscape that continues to advance our understanding of this critical health issue.
Main research focus of the all papers
The co-words analysis of the literature surrounding ST Elevation Myocardial Infarction (STEMI) provided valuable insights into the focus and interconnections among the various topics studied within this critical area of cardiovascular research. The keywords extracted from the publications illuminated the multifaceted nature of STEMI and its associated conditions, treatments, and outcomes ( Fig. 1 ).
Central to the analysis was the emphasis on acute conditions, specifically “Acute Myocardial Infarction” and “Acute Coronary Syndrome,” which served as primary contexts for many studies. The terms “Angina Pectoris” and “Heart Infarction” further illustrated the spectrum of ischemic heart diseases addressed in the literature. Various diagnostic and therapeutic approaches were explored, including “Coronary Angiography,” “Angioplasty,” and “Percutaneous Coronary Intervention,” highlighting the advancements in techniques to restore coronary artery blood flow and manage acute events.
Several pharmacological agents emerged prominently in the co-words analysis. The use of “Acetylsalicylic Acid,” commonly known as Aspirin, was frequently cited alongside “Anticoagulant Agents” and “Antithrombocytic Agents,” indicating the importance of antiplatelet therapy in preventing thrombus formation during acute coronary events. Additionally, the inclusion of “Clopidogrel” and “Ticagrelor” signified ongoing investigations into dual antiplatelet therapy and its efficacy in reducing cardiovascular mortality.
The analysis also underscored the significance of biomarkers and diagnostic tools. Keywords such as “C Reactive Protein,” “Creatine Kinase,” and “Troponin I” were integral in assessing myocardial injury and guiding treatment decisions. The association of “Electrocardiogram” and “Electrocardiography” further highlighted the essential role of these diagnostics in the timely identification of “ST Segment Elevation” and other abnormalities indicative of acute myocardial events.
Outcomes related to patient management were encapsulated through terms like “Cardiogenic Shock,” “Heart Failure,” and “Hospital Mortality,” which pointed to the critical nature of patient responses to interventions. “Fibrinolytic Therapy” and “Thrombolytic Therapy,” including agents like “Streptokinase,” were evaluated for their roles in enhancing blood clot lysis, emphasizing the continued relevance of these therapies despite the evolution of treatment paradigms.
Moreover, the literature examined various risk factors and comorbidities associated with STEMI. “Diabetes Mellitus” and “Hypertension” were frequently mentioned, indicating their roles in disease severity and outcomes. The keywords “Ventricular Function, Left” and “Heart Left Ventricle Function” also indicated a focus on the functional aspects of the heart post-myocardial infarction, reflecting the long-term implications of acute events on cardiovascular health.
In conclusion, the co-words analysis provided a cohesive overview of the research focus in the field of STEMI. By examining the interplay of keywords, it became evident that the literature encompassed a wide array of topics, from acute management strategies and pharmacological interventions to diagnostic methodologies and patient outcomes, collectively advancing the understanding of this critical cardiovascular condition.
Descriptive details about the top 100 most cited papers
The analysis of the top 100 most cited papers on ST-Elevation Myocardial Infarction (STEMI) between 1981 and 2018 revealed significant trends in the impact and publication characteristics of these influential works. Over the span of almost four decades, the 100 selected papers, comprising 79 articles and 21 reviews, have been published across 18 sources, including both journals and books. The annual growth rate of these highly cited publications showed a decrease of -1.86%, with a document average age of 22.9 years, reflecting the long-standing influence of foundational research in the STEMI field.
In terms of citation performance over time, papers from the 1980s consistently demonstrated high mean total citations per article (MeanTCperArt). For instance, papers published in 1985 and 1986 had MeanTCperArt values of 1721 and 2294.5, respectively, highlighting the impact of early research in shaping the understanding and management of STEMI. Notably, a 1987 publication showed the highest MeanTCperArt among early works, with an impressive 3537 citations and an annual mean citation rate (MeanTCperYear) of 93.08. This peak reflects the influential nature of research in that year, likely marking a pivotal development in STEMI knowledge or treatment approaches.
The citation performance varied across subsequent years, with papers published in 2003, 2012, and 2018 showing particularly high MeanTCperArt values of 2514, 2839.5, and 7555, respectively. The sharp increase in MeanTCperYear for papers from 2012 and 2018, reaching 218.42 and 1079.29, respectively, indicates that more recent studies rapidly gained recognition and citations, likely due to advancements in STEMI research and more robust methodologies. The 2018 publication, in particular, demonstrated a remarkable citation rate, suggesting it addressed a highly relevant topic or breakthrough in STEMI management or treatment.
The “citable years” metric provided insights into the longevity of impact for these publications. Papers from the early 1980s, such as those from 1981 and 1982, had the longest citable years at 44 and 43, respectively, while those published in recent years showed progressively shorter citable durations. This trend aligns with the nature of scientific progress, where newer studies may be expected to accrue citations more rapidly in response to current research needs and technological advancements.
Overall, the results underscore the evolving focus and citation impact in the STEMI literature, with foundational studies from the 1980s continuing to exert influence, while recent publications gain rapid recognition, reflecting ongoing advancements and the dynamic landscape of STEMI research.
Top authors, universities, and countries
The analysis of authorship and collaboration within the top 100 most cited papers on STEMI revealed distinct patterns in publication metrics and collaborative efforts. A total of 2,690 authors contributed to these highly cited studies, indicating a broad base of academic engagement in STEMI research. Out of these authors, only nine contributed single-authored documents, resulting in 10 single-authored papers in total. This low number of single-authored publications highlights the collaborative nature of the field, where research teams are commonly involved in generating impactful work.
On average, there were 32.5 co-authors per document, illustrating the trend towards extensive collaboration in STEMI research. Additionally, international collaboration played a substantial role, with 22% of papers involving authors from multiple countries. This indicates a strong global engagement and exchange of knowledge, which likely contributed to the robustness and interdisciplinary nature of the findings in STEMI studies.
To comprehensively assess author performance, we recognized that a single indicator may not sufficiently capture the multifaceted contributions of researchers. , Therefore, we employed a series of indicators to provide a more robust and nuanced evaluation. These indicators included the number of publications and total citations, which offer insights into an author’s productivity and impact. Additionally, the h-index, g-index, and m-index were utilized to account for both the quantity and quality of an author’s work over time, with the h-index reflecting consistency, the g-index emphasizing higher-cited papers, and the m-index showing the rate of influence relative to career length. The HG Composite and Q2-Index further refined this analysis by integrating multiple metrics, allowing for a more comprehensive depiction of author influence and research quality within the field.
The most prolific and influential authors in this dataset included Antman EM, Hochman JS, and Anderson JL, each of whom made significant contributions as measured by various bibliometric indicators. Antman EM led with 17 publications, accruing a total of 22,348 citations, and held an h-index of 17. This high citation count reflects Antman’s substantial influence in the field. Antman also showed high values across other metrics, with a g-index of 17, an m-index of 0.586, and an HG Composite Index of 17. Notably, the Q2 Index score of 3.16 further underscores Antman’s impact and consistent contributions to high-quality, frequently cited research.
Similarly, Hochman JS and Anderson JL followed with 12 and 11 publications, respectively, and total citations of 14,622 and 13,931. Both authors demonstrated considerable impact with h-indices and g-indices of 12 and 11, respectively, suggesting sustained relevance across multiple publications. The m-indices for Hochman (0.48) and Anderson (0.379) provide insights into their ongoing influence in STEMI research. Their Q2 Index values, 2.40 for Hochman and 2.04 for Anderson, indicate a strong standing in terms of citation impact and research quality within the domain.
Overall, these results reveal that STEMI research is highly collaborative, with leading authors contributing a large volume of influential work that consistently attracts high citations. The data emphasizes the importance of co-authorship and international partnerships in advancing the field and underscores the significant role of top researchers whose work has laid a foundation for ongoing STEMI studies.
The analysis of institutional and national contributions to the top 100 most cited papers on STEMI revealed notable sources of research output and citation impact. Gasthuisberg University Hospital led with 57 articles, demonstrating its significant role in producing influential research on STEMI. This was followed by University Medical Center with 18 articles and Brigham and Women’s Hospital with 17 articles, both of which contributed prominently to the body of knowledge in the field.
At the national level, the United States emerged as the most impactful contributor, with a total of 27,692 citations. This high citation count underscores the influence and global reach of U.S.based research on STEMI. France ranked second, with 8,131 citations, highlighting its important role in advancing STEMI research within Europe and internationally.
These results indicate that while key institutions such as Gasthuisberg University Hospital have made substantial contributions in terms of article output, the U.S. leads in citation impact, reflecting the strong influence of American research within the STEMI domain.
Collaboration networks for authors, universities, and countries are available upon request to provide a comprehensive view of collaborative patterns and partnerships within STEMI research. Additionally, detailed dynamics for top authors, leading universities, and contributing countries can be provided on demand, offering insights into the key players and their interactions in advancing the field.
The research focus of the top 100 most cited documents
To understand the primary focus of the papers, a co-words analysis was conducted, which allowed us to examine the recurring terms and thematic emphasis within the body of research. , This analysis specifically targeted uni-grams, bi-grams, and tri-grams, capturing single terms, two-word combinations, and three-word combinations respectively. This approach provided deeper insights into core topics, relationships, and trends, allowing for a structured overview of key themes within STEMI research.
Uni gram analysis
The titles of the top 100 most cited papers in STEMI research indicated a strong focus on therapeutic and clinical approaches, as well as outcome measures ( Fig. 2 ). The term “aspirin” highlighted the importance of antiplatelet agents in managing coronary syndromes, underscoring aspirin’s role in reducing thrombotic complications. “Plasminogen” suggested an emphasis on thrombolysis mechanisms, given its critical role in dissolving clots.
“Intravenous” demonstrated that routes of administration, particularly for emergency medications, were a significant area of interest. The inclusion of “comparison” and “results” pointed to examinations of different strategies to determine efficacy and safety. “Mortality” emphasized the high stakes in STEMI treatment, with survival rates often assessed as a primary outcome.
The term “effects” reflected a focus on analyzing the outcomes associated with various interventions, while “thrombolytic” highlighted the importance of clot-dissolving therapies in emergency STEMI care. “Trial” underscored the reliance on evidence-based practices, with clinical trials forming the foundation of management strategies. The frequent appearance of “therapy” pointed to the range of interventions studied within this field.
“Randomised” indicated adherence to high methodological standards, with randomized controlled trials (RCTs) serving as a gold standard in establishing efficacy. “Angioplasty,” specifically percutaneous interventions, was frequently analyzed for its role in revascularization and improving outcomes. “Primary” suggested a focus on primary angioplasty as a preferred approach over thrombolytics for STEMI, while “acute” pointed to the emergency nature of the condition and the need for immediate intervention.
“Coronary” and “ventricular” highlighted the anatomical focus, with studies often centering on artery obstructions and ventricular function post-infarction. “Myocardial” and “infarction” underscored the centrality of myocardial injury in STEMI, while “unstable” reflected the high-risk nature of patients. The term “versus” was commonly used in comparative studies, particularly when assessing different therapeutic interventions.
“Patients” indicated the patient-centered nature of this research, while “heart” represented the primary organ studied in these contexts. “Association” often referred to cardiovascular risk factors, while “cells” suggested a focus on cellular responses within the myocardium. “Double-blind” underscored the rigor in reducing bias, while “guidelines” and “management” reflected significant efforts to standardize care for optimal outcomes.
The appearance of “American” indicated contributions from U.S. institutions or adherence to standards by the American College of Cardiology and American Heart Association (ACC/AHA). “ST-elevation,” “syndrome,” and “st-segment” pointed directly to STEMI as a specific focus, and terms such as “guideline,” “focused,” and “update” reflected ongoing efforts to refine treatment protocols.
Bi gram analysis
Studies ( Fig. 3 ) often centered on “randomised trial” approaches to ensure rigor in assessing the efficacy of therapies for acute coronary conditions, such as the use of “plasminogen activator” and “tissue plasminogen” to promote thrombolysis in blocked arteries. The frequent mention of “coronary angioplasty” underscored its critical role in revascularization, offering a primary intervention to restore blood flow during an “acute myocardial” event.
