Impact of revised criteria for myocardial infarction.

Abstract

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, …