Abstract
The management of acute coronary syndromes (ACS) is a true success story. Indeed, in 1955 when the then President of the United States Dwight D. Eisenhower had an infarction, the President’s personal physician, Dr Howard Snyder, interpreted his symptoms as a gastrointestinal illness.1 It took 10 h to transfer him to a local hospital where an electrocardiograph had to be brought in from another hospital—a situation that today would be malpractice.2 The electrocardiogram (ECG) showed an anterolateral acute myocardial infarction (AMI) with ST-segment elevation myocardial infarction or a STEMI as we would call it today based on the recent definition of myocardial infarction (MI).3 Based on the Fourth Universal Definition of Myocardial Infarction Eisenhower experienced a clear cut Type 1 infarction (Table 1). Today, we distinguish not only five types of infarction, but also myocardial injury, defined by an elevated cardiac troponin (cTn) value, which is also associated with an adverse prognosis. To differentiate myocardial injury from MI, criteria in addition to abnormal biomarkers are required such as ECG changes and evidence of ischaemia.
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