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(Circulation. 2002;106:e9033.)
© 2002 American Heart Association, Inc.

Cardiovascular News

Robin Fox, FRCP

Circulation Newswriter

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Impact of Revised Criteria for Myocardial Infarction

At this year’s European Society of Cardiology (ESC) Congress, it was clear that the revised criteria for myocardial infarction (MI), proposed in 2000 by the ESC and the American College of Cardiology, have yet to gain general approval. The criteria depend on troponin and creatine kinase-MB (especially troponin) as markers of myocardial necrosis, and any such necrosis as a result of ischemia, however small, signifies MI. The proponents, or "troponites," declare that the new laboratory-dependent criteria offer more sensitive diagnosis and stronger prognostic information, and allow for more aggressive management. The "antitroponites" question the clinical relevance of small increases in troponin and worry about the clinical and social implications of labeling numerous extra people as having MI. Several speakers at the Congress had retrospectively assessed the diagnostic impact of the new definition. For example, Dr S. Wilson, from the Cardiology Department, Newham Healthcare Trust, London, UK, reported on 964 patients with acute coronary syndromes. Of these, 297 fulfilled the old criteria for MI and 481 fulfilled the new. In percentage terms, the ratio of unstable angina to MI fell from 69/31 to 42/58, and the in-hospital fatality rate for MI (new definition) fell by more than one-third. Dr G.A. Large, from the Department of Cardiovascular Medicine, University Hospital Nottingham, Nottingham, UK, analyzed data on 1348 patients seen in a teaching hospital. Of these, 385 met the old criteria for MI and an additional 240 the new. These extra MI patients spent less time in the hospital and had a lower . . . [Full Text of this Article]