The new and old definitions of acute myocardial infarction: a data-based comparison

Area of Science:

• Cardiology
• Medical Diagnostics

Background:

• Acute myocardial infarction (AMI) diagnosis relies on established criteria.
• The World Health Organization (WHO) established traditional criteria for AMI.
• The European Society of Cardiology-American College of Cardiology (ESC-ACC) developed newer diagnostic guidelines for AMI.

Purpose of the Study:

• To compare the agreement between the ESC-ACC and WHO definitions of AMI.
• To quantify discrepancies in AMI diagnosis based on these two definition sets.

Main Methods:

• Adult emergency department patients with elevated cardiac biomarkers were assessed.
• Diagnosis of AMI was determined using both ESC-ACC and WHO criteria.
• Agreement and reasons for disagreement between the definitions were analyzed.

Main Results:

• Out of 339 patients, 196 (58%) met at least one AMI definition.
• A significant discordance rate of 64% was observed between the ESC-ACC and WHO definitions.
• 104 patients (53%) met only the ESC-ACC definition, while 22 (11%) met only the WHO definition.
• Among those meeting only the ESC-ACC definition, 36% did not meet any traditional WHO criteria.

Conclusions:

• There is substantial discordance between the ESC-ACC and WHO definitions of AMI.
• The ESC-ACC definition identifies more cases of AMI compared to the WHO definition.
• A significant proportion of patients diagnosed under the ESC-ACC criteria would not have been classified as AMI under traditional WHO guidelines.