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The new definition of myocardial infarction--can we use it?

Stefan Agewall1, Christian Löwbeer

  • 1Department of Cardiology, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden. stefan.agewall@karolinska.se

Clinical Cardiology
|March 11, 2005
PubMed

Insights

The new European Society of Cardiology/American College of Cardiology definition for myocardial infarction (MI) identified 3-32% more MIs than Swedish criteria. Some patients diagnosed with MI using the new criteria presented with other conditions like heart failure.

Area of Science:

  • Cardiology
  • Clinical Diagnostics

Background:

  • The European Society of Cardiology/American College of Cardiology (ESC/ACC) jointly established new diagnostic criteria for myocardial infarction (MI).
  • Existing Swedish diagnostic criteria for acute MI are widely used in clinical practice.

Purpose of the Study:

  • To compare the diagnostic outcomes of the new ESC/ACC criteria versus the Swedish diagnostic criteria for acute MI.
  • To evaluate the clinical presentation of patients diagnosed with MI under the new ESC/ACC criteria.

Main Methods:

  • Cardiac biomarkers including creatine kinase-MB, troponin I, and troponin T were measured.
  • 525 consecutive patients admitted to a university hospital coronary care unit (CCU) with suspected myocardial ischemia were analyzed.
  • Patient data were compared between the ESC/ACC and Swedish diagnostic criteria.

Main Results:

  • The ESC/ACC definition resulted in a 3-32% increase in MI diagnoses compared to Swedish criteria.
  • A significant proportion of patients diagnosed with MI under ESC/ACC criteria presented with symptoms other than typical ischemia, such as heart failure, tachycardia, pulmonary embolism, or sepsis.
  • Most patients identified by ESC/ACC criteria had myocardial ischemia as the primary symptom.

Conclusions:

  • The ESC/ACC definition of MI leads to a higher number of diagnoses compared to traditional Swedish criteria.
  • The clinical significance of MI diagnoses in patients presenting with conditions like acute heart failure and tachycardia remains uncertain.
  • Further clinical studies are needed to guide the classification of MI in patients with atypical presentations.
Abstract

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