The British Cardiac Society Working Group definition of myocardial infarction: implications for practice

Rajiv Das ¹, Niamh Kilcullen ¹, Christine Morrell ¹, Mike B Robinson ², Julian H Barth ³ and Alistair S Hall ^4*

¹ BHF Heart Research Centre, Leeds, United Kingdom
² Nuffield Institute for Health, Leeds, United Kingdom
³ Clinical Biochemistry, Leeds General Infirmary, United Kingdom
⁴ The BHF Heart Research Centre, United Kingdom

^* To whom correspondence should be addressed. E-mail: a.s.hall{at}leeds.ac.uk.

Accepted 7 April 2005

Abstract

Objective: To assess the impact on observed mortality of the British Cardiac Society definition of myocardial infarction in 11 UK hospitals.

Design: Prospective observational registry.

Setting: 11 adjacent hospitals in the West Yorkshire region.

Patients: 2,499 patients with ACS were identified during a six-month window period (April 28th to October 28th 2003). Demographic, clinical and treatment variables were collected on all patients and their mortality status was monitored through the Office of National Statistics. Patients were categorised into 3 groups according to the BCS definition of MI: "ACS with unstable angina"; "ACS with myocyte necrosis" and "ACS with clinical MI".

Results: 30-day mortality across the groups was 4.5%, 10.4% and 12.9% p<0.001 (ACS with unstable angina, ACS with myocyte necrosis and ACS with clinical MI respectively). At 6 months the mortality for patients in groups, "ACS with clinical MI" and "ACS with myocyte necrosis" were similar (19.2% vs. 18.7%) being higher than for "ACS with unstable angina" (8.6%). Same admission PCI was similar in groups with clinical MI and myocyte necrosis (11.1%, 10.7% respectively) as was CABG (2.6%, 2.7% respectively). However, there were significant differences between these two groups in the prescribing of secondary prevention (aspirin, statins, beta-blockers and ACE-inhibitors p<0.001).

Conclusions: At 30-days the new BCS categories for myocardial infarction predict three distinct outcomes. However, within a contemporary UK population this was no longer apparent at 6 months as mortality rates for patients with "ACS with myocyte necrosis" had risen to the same level as those for patients "ACS with clinical MI". One possible explanation for this is the apparent under-use of drugs known to improve prognosis after traditional myocardial infarction.

Keywords: acute coronary syndrome, epidemiology, myocardial infarction

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