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(Circulation. 2000;102:e9023.)
© 2000 American Heart Association, Inc.

Cardiovascular News

Cardiovascular News

Robin Fox, MB, FRCP

Myocardial Infarction Redefined

If the recommendations of a new consensus document¹ are accepted, the world will see an increase in the recorded incidence of myocardial infarction (MI) but a fall in the case fatality rate. Declaring the World Health Organization’s definition of MI outmoded, a joint committee of the European Society of Cardiology and the American College of Cardiology has produced new criteria that depend heavily on biochemical markers, specifically, the cardiac troponins. The most striking proposal is that any myocardial necrosis due to ischemia, however small, will be labeled as MI. Troponins can detect an area of necrosis weighing as little as 1 g. The new definition follows.

Criteria for acute, evolving, or recent MI

1. A typical rise and gradual fall (troponin) or more rapid rise and fall (creatine kinase [CK]-MB) of biochemical markers of myocardial necrosis with 1 of the following:
   
2. Ischemic symptoms
   
3. Development of pathological Q waves on the ECG
   
4. ECG changes indicative of ischemia (ST segment elevation or depression)
   
5. Coronary artery intervention (eg, coronary angioplasty)
   
6. Pathological findings of an acute MI
   

Criteria for established MI

1. The development of new pathological Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed.
   
2. Pathological findings of a healed or healing MI.
   

Announcing the document on August 28, 2000, at the 22nd Congress of the European Society of Cardiology in Amsterdam, Dr J.S. Alpert of Tucson, Ariz, and . . . [Full Text of this Article]