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.
- cardiac troponin I
- myocardial infarction
- 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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