European Heart Journal Advance Access originally published online on April 6, 2005
European Heart Journal 2005 26(17):1719-1725; doi:10.1093/eurheartj/ehi185
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A new definition for myocardial infarction: what difference does it make?
1Department of Epidemiology, KTL-National Public Health Institute, Mannerheimintie 166, FI-00300 Helsinki, Finland
2Kuopio University Hospital, Kuopio, Finland
3Central Hospital of North Karelia, Joensuu, Finland
4Turku University Hospital, Turku, Finland
5Oulu City Hospital, Oulu, Finland
6Turku City Hospital, Turku, Finland
7Oulu University Hospital and Biocenter Oulu, Oulu, Finland
Received 7 October 2004; revised 21 January 2005; accepted 27 January 2005; online publish-ahead-of-print 6 April 2005.
* Corresponding author. Tel: +358 9 4744 8620; fax: +358 9 4744 8338. E-mail address: veikko.salomaa{at}ktl.fi
Aims As a response to changing diagnostic tools of myocardial infarction (MI), new case definitions for acute coronary events were published in 2003 as the American Heart Association Scientific Statement. We assessed the new definition in hospitalized patients in a large population-based MI register study.
Methods and results We identified all suspected acute coronary syndromes with data either on troponin T or on troponin I and at least one of the enzymatic markers of myocardial injury (n=6104). The 2003 definition with the use of troponins identified 83% more definite MIs than the WHO MONICA definition using cardiac enzymes. The additional patients were older, had more often diabetes, and received less often thrombolysis and revascularization than those having MI by both definitions. Adjusting for age, sex, study area, and study year, the additional patients with their first MI aged 25–74 had a higher risk of cardiovascular death within 1 year than patients having definite MI by both definitions (hazard ratio 1.6, 95% CI 1.1–2.2).
Conclusion The changing diagnostic criteria present a considerable challenge for the assessment of long-term trends in MI events in the community as well as for longitudinal studies of the natural history of MI. The 2003 definition, when applied using troponins, identified a sizable new group of MI patients, among persons with suspected acute coronary syndrome, at high risk of a recurrent event.
Key Words: Coronary disease • Myocardial infarction • Prognosis • Troponins
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