Redefinition of myocardial infarction: new challenges and opportunities

Abstract

Heart disease is the number one cause of death in the western world and as such constitutes an immense public health problem.1,2 The analysis of the trends in the incidence and outcome of myocardial infarction coupled to that of coronary disease mortality provides crucial insights into the determinants of heart disease, which is essential to its treatment and prevention. For example, in the face of stable incidence trends, a decline in coronary mortality most likely reflects the impact of secondary prevention and medical care, whereas increasing incidence of disease conversely would point to primary prevention. Within this framework, it is important to recognize that the trends in the incidence and outcome of coronary disease are complex, likely multifactorial, and evolve over time. Indeed, as the respective role of these two theoretical determinants varies across person, time, and place, continued surveillance is essential to detect change in the trends and their determinants and to evaluate the effectiveness of clinical and public health strategies to combat coronary disease.3–5 Effective surveillance in turn mandates standardization of the criteria used to define the events under surveillance. This is a prerequisite for the validity and interpretation of trends measured in different settings and in different time periods. Myocardial infarction plays a crucial role in the surveillance of the population burden of coronary disease in part related to the existence of established criteria for its diagnosis, which are amenable to standardization. Thus, the medical and scientific communities have tracked the incidence of myocardial infarction over time as chief indicator of progress in the battle against coronary disease,6 studied the prognosis of myocardial infarction, and dedicated enormous resources to improve it. Within this context, it is thus intuitive that a common definition of myocardial infarction, which can be used by … *Corresponding author. Tel: +1 507 284 0519; fax: +1 507 266 0228. E-mail address : roger.veronique{at}mayo.edu