Myocardial infarction: redefined or reinvented? | Heart

Subscribe
Log In More

Log in via Institution
Log in via OpenAthens
Log in via BCS

Log in using your username and password
For personal accounts OR managers of institutional accounts

Username *

Password *

Forgot your log in details?Register a new account?
Forgot your user name or password?
Basket
Search More

Search for this keyword

Advanced search

Responses

Editorial

Myocardial infarction: redefined or reinvented?

Free

Compose a Response to This Article

Compose Response

Title *

Author Information

Contributors
First Name and Middle Initial * First or given name, e.g. 'Peter'. Last Name * Your last, or family, name, e.g. 'MacMoody'. Email Address * Your email address, e.g. higgs-boson@gmail.com Occupation * Your role and/or occupation, e.g. 'Orthopedic Surgeon'. Affiliation * Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

No

Please describe the competing interests

PLEASE NOTE:

A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.

I agree to and have read the terms and conditions for rapid responses and BMJ Privacy Notice *

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

Redefining myocardial infarction
John S Birkhead
Published on: 4 July 2002

Published on: 4 July 2002
Redefining myocardial infarction
- John S Birkhead, Consultant Cardiologist
Dear Editor
Professor Dargie's closely argued Editorial is to be welcomed in advising caution in accepting the recommendations of the Consensus Document which offers a redefinition of myocardial infarction.[1] I strongly support his recommendation that we should continue to use the present way until more robust evidence supports change. There should be no problem with the use of troponins as one part of the risk stra...
Show More

Dear Editor
Professor Dargie's closely argued Editorial is to be welcomed in advising caution in accepting the recommendations of the Consensus Document which offers a redefinition of myocardial infarction.[1] I strongly support his recommendation that we should continue to use the present way until more robust evidence supports change. There should be no problem with the use of troponins as one part of the risk stratification of patients with acute coronary ischaemia, but there is a substantial problem with the label of myocardial infarction for anyone who, in appropriate clincial circumstances, has an elevated troponin. Even the consensus document is less than plausible on this point; ’this change in the definition of MI seems reasonable, because it has been definitively shown that any amount of cardiac damage, as detected by cardiac troponins, implies a worsened long-term outcome for the patient.’ An unarguable case for troponins, but a poor justification for the new label. We cannot ignore the impact of this label for our patients. The response in this country, from the evidence of the MINAP database (on file), using data from the last six months of 2001, has been very cautious. Of more than 5000 patients having a final diagnosis of definite infarction, and for whom markers and cardiac enzymes were reported, this diagnosis was supported by a troponin estimation alone in 14.6 %, both troponin and creatine kinase in 10.5 %, and by creatine kinase alone in 74.8 %. Where troponin was used the large majority (> 90 %) had a troponin value of > 20 microgram/L, and by contrast virtually none had a diagnosis based on the consensus recommendation. Clearly this has not yet found favour with clinicians. Professor Dargie's plea for standardisation of troponin assays should not be ignored, and some acceptance of the reality that change will be slow is important. A more realistic cut off beyond which the label of myocardial infarction might be applied will please the pragmatists more that the purists, but would be welcomed by clinicians. A value of 100 times the minimum detectable concentration( MDC) might be considered; it has no less validity than the present cut off point of ten times the MDC used empirically by some colleagues.
J S Birkhead
Clinical Lead
MINAP
Clinical Effectiveness and Evaluation Unit
Royal College of Physicians
London
Reference
(1) Myocardial infarction redefined - A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. European Heart Journal 2000;21:1502-13.
Show Less

Conflict of Interest:
None declared.
- Back to top