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Societies publish third universal definition of MI
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MUNICH — The European Society of Cardiology, American College of Cardiology, American Heart Association and World Heart Federation jointly developed an updated definition of MI that can be used by cardiologists to diagnose patients and define endpoints in clinical trials worldwide.
The first joint document in this area was the ESC/ACC criteria for redefinition of MI, which was published in 2000. In 2007, the AHA and WHF joined the task force and a universal definition was developed, according to a press release.
The 2012 document outlines the levels of troponin required for a diagnosis of procedural-related MI after PCI, CABG or other cardiac and noncardiac procedures.
“This is a controversial area because interventional cardiologists and surgeons do not want MI as a complication. It means that they want to set the levels of troponin as high as possible. It was also difficult to reach a consensus because it’s impossible to conduct a clinical trial to find the answer,” Kristian Thygesen, MD, co-chair of the document task force, stated in the release. Thygesen presented the updated MI definition at the European Society of Cardiology Congress.
The update also features a new section describing situations in which troponin levels can be elevated in myocardial injury and cell death in conditions without overt myocardial ischemia to help clinicians and scientists understand how they differ from MI.
The new definition was extensively discussed in more than four sessions at the congress.
“The newly revised universal definition of MI is based on the latest scientific information concerning this critically important diagnosis. There is much new material in this third revision, including discussions on how to interpret elevated blood troponin levels in patients with renal failure, HF, critical illness, and various cardiac and noncardiac procedures. There is also revision of the, at times, confusing category of type 2 MI,” task force member Joseph Alpert, MD, told Cardiology Today. Alpert is also a member of the Cardiology Today Editorial Board.
Joseph Alpert
“The task force that prepared this revision is convinced that it will aid clinicians and clinical scientists in standardizing the diagnosis of acute MI,” Alpert said.
During the development of the third universal definition, the task force communicated with the FDA and it is anticipated that this definition could be used as the basis for clinical trial protocols designed according to FDA regulations, according to information in the release.
“This is significant because it will help to standardize the way MI is defined in clinical trials, making comparisons between trials more meaningful,” Thygesen stated in the release.
The updated definition was published simultaneously in the European Heart Journal, Journal of the American College of Cardiology, Circulation, Global Heart and Nature Reviews Cardiology. – by Katie Kalvaitis
For more information:
Thygesen K. Circulation. 2012;doi:10.1161/CIR.0b013e31826e1058.
Disclosure: Dr. Alpert reports direct personal payment from Bayer, Daiichi Sankyo, Johnson & Johnson, Novartis, Sanofi-Aventis and Servier; payment to his institution from Boehringer-Ingelheim and Genzyme; receipt of royalties for intellectual property from Duke University; and research funding from the TIMI group. Dr. Thygesen reports direct personal payment from the Danish Heart Foundation, Edwards Lifesciences, Roche Diagnostics, Roche Pharma, Servier and St. Jude Medical, as well as research funding from the Danish Heart Foundation, Roche Diagnostics, Roche Pharma and Tryg Fonden.