New definition of myocardial infarction

doi:10.1136/bmj.a3078

Published 24 December 2008, doi:10.1136/bmj.a3078
Cite this as: BMJ 2008;337:a3078

Editorials

New definition of myocardial infarction

Features new subtypes of infarction and puts high demands ondiagnostic assays

The first 150 words of the full text of this article appear below.

The evolution of the definition of acute myocardial infarctiontells a fascinating story of medical progress. Between the publicationof the initial World Health Organization’s classificationin 1979,¹ and that published by the redefinition committee ofthe American College of Cardiology, American Heart Association,and European Society of Cardiology in 2000, much of our diagnosticreasoning changed.² Biochemistry now takes centre stage, andthe measurement of cardiac troponins has substantially increaseddiagnostic sensitivity.

Cardiologists predicted that these changes in diagnostic criteriaand sensitivity would increase the incidence of acute myocardialinfarction.³ They also predicted that the redefinition wouldhave implications for individual patients and healthcare expenditure.Their predictions turned out to be correct, at least in part.A national registry in Norway found a 33% increase in acutemyocardial infarction after the implementation of the 2000 criteria,⁴and the Swedish Nationwide Centre of Epidemiology documentedan abrupt 14% increase.⁵

Interest . . . [Full text of this article]

Dan Atar, professor and head of cardiology

¹ Division of Cardiology, Aker University Hospital and Faculty of Medicine, University of Oslo, 0514 Oslo, Norway

dan.atar@online.no

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