Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction. Issue 4 (1st October 2002)

• Record Type: Journal Article
• Authors: Ferguson, J L; Beckett, G J; Stoddart, M; Walker, S W; Fox, K A A
• Is Part Of: Heart. Volume 88:Issue 4(2002)
• Page Start: 343
• Page End: 347
• Publication Date: 2002-10-01
• Subjects: cardiac troponin I -- myocardial infarction -- epidemiology; ACC, American College of Cardiology, CK, creatine kinase -- CV, coefficient of variation -- ESC, European Society of Cardiology -- WHO, World Health Organization; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heart.88.4.343
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objectives: To investigate the impact of the redefinition of the diagnostic criteria for myocardial infarction on its apparent incidence in a non-selected and representative series of patients admitted with acute chest pain. Design: Single centre prospective study. Setting: Medical assessment unit and cardiology wards of an inner city university hospital. Patients: 80 consecutive patients aged over 25 years admitted with suspected ischaemic acute chest pain (excluding those where the ECG indicated definite myocardial infarction). Interventions: Measurement of concentrations of conventional cardiac biomarkers (creatine kinase and its MB isoenzyme, CK-MB) and concentrations of the highly specific diagnostic indicator of myocardial damage, cardiac troponin I (cTnI) 12–24 hours after the onset of acute chest pain. Main outcome measures: Frequency of myocardial infarction as assessed by conventional diagnostic criteria (creatine kinase and CK-MB) plus clinical symptoms of infarction, versus frequency of infarction based on high sensitivity troponin assays. Results: Among patients with acute coronary syndromes but non-diagnostic ECG changes, 40% (32/80) fulfilled the new criteria for myocardial infarction using high sensitivity cTnI measurement, compared with 29% (23/80) using the conventional diagnostic criteria for myocardial infarction. Conclusions: The implications of the redefinition of myocardial infarction on patients, their care, and the use of health care resources are substantial.