This article is more than 5 years old. Information may no longer be current.
New MI definition includes previously undertreated, high risk population
The WHO will publish the redefinition in 2007.
Click Here to Manage Email Alerts
Progress in the identification and quantification of biochemical markers of myocardial injury have led to a redefinition of myocardial infarction.
The new definition, set for publication in 2007 by the World Health Organization, identifies high risk people with acute coronary syndrome and elevated blood troponin levels, despite normal blood determinations for creatine kinase and CKMB previously undertreated.
Joseph S. Alpert, MD, the Robert S. and Irene P. Flinn Professor of Medicine and head of the department of medicine, University of Arizona Health Science Center, Tucson, and Cardiology Today editorial board member, presented the new definition at the World Congress of Cardiology Meeting 2006 held last month in Barcelona.
Since previously unidentified, small myocardial infarcts are now detected, the new definition of MI has many implications, including changes in therapy, epidemiology and public policy, Alpert wrote in a press release from the European Society of Cardiology.
New research, performed over the last six years, made it imperative to update the redefinition. An international task force worked on it for three years and is assembling its final report.
First update since 2001
The original redefinition report, published simultaneously in the European Heart Journal and Journal of the American College of Cardiology in 2000, reviewed the reasoning and data that led to the redefinition of acute MI. The first revision occurred in 2001.
The WHO previously defined acute MI as a combination of at least two of the following three components: symptoms consistent with an acute MI, ECG changes diagnostic of an acute MI and a temporal pattern of enzyme rise and fall consistent with myocardial cell death. The enzyme that was employed in this traditional definition was creatine kinase and its MB subtraction.
However, CK and CKMB measurements failed to identify a subgroup of patients with an ACS who were at increased risk for morbidity and mortality.
The clear association of troponin elevation with increased mortality, along with the availability of therapy that diminishes the risk, led to the current redefinition of acute MI.
For more information:
- Alpert JS. Guideline implementation: A real world view. Presented at: The World Congress of Cardiology 2006; Sept. 2-6, 2006; Barcelona.