CARDIOVASCULAR MEDICINE

Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction

J L Ferguson¹, G J Beckett², M Stoddart², S W Walker², K A A Fox¹

¹ Department of Cardiology, The Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, UK
² Department of Clinical Biochemistry, The Royal Infirmary of Edinburgh

Correspondence to:
Correspondence to:
Professor Keith A A Fox, Cardiovascular Research, Department of Medical and Radiological Sciences, The Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh EH3 9YW, UK;
k.a.a.fox{at}ed.ac.uk

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.

Keywords: cardiac troponin I; myocardial infarction; epidemiology

Abbreviations: ACC, American College of Cardiology, CK, creatine kinase; CV, coefficient of variation; ESC, European Society of Cardiology; WHO, World Health Organization

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