New definition of myocardial infarction

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a3078 (Published 24 December 2008) Cite this as: BMJ 2008;337:a3078
  1. Dan Atar, professor and head of cardiology
  1. 1Division of Cardiology, Aker University Hospital and Faculty of Medicine, University of Oslo, 0514 Oslo, Norway
  1. dan.atar{at}online.no

    Features new subtypes of infarction and puts high demands on diagnostic assays

    The evolution of the definition of acute myocardial infarction tells a fascinating story of medical progress. Between the publication of the initial World Health Organization’s classification in 1979,1 and that published by the redefinition committee of the American College of Cardiology, American Heart Association, and European Society of Cardiology in 2000, much of our diagnostic reasoning changed.2 Biochemistry now takes centre stage, and the measurement of cardiac troponins has substantially increased diagnostic sensitivity.

    Cardiologists predicted that these changes in diagnostic criteria and sensitivity would increase the incidence of acute myocardial infarction.3 They also predicted that the redefinition would have 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 acute myocardial infarction after the implementation of the 2000 criteria, …

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