Diagnosis of myocardial infarction using the universal definition was an independent predictor of 10-year mortality (HR 1.58; 95% CI 1.07-2.40; P=0.03) in patients with acute coronary syndrome.
Cohort (n=676)
No
Does the universal definition of myocardial infarction better predict 10-year mortality compared to older definitions in patients with acute coronary syndrome?
The universal definition of myocardial infarction based on cardiac troponin increases the diagnosis rate by 25% and serves as an independent predictor of 10-year mortality in ACS patients.
Effect estimate: HR 1.58 (95% CI 1.07-2.40)
p-value: p=0.03
AIMS: Redefinition of myocardial infarction (MI) based on specific cardiac troponins (cTn) was universally accepted in 2007. The new definition has been widely discussed for including a large spectrum of quantitative myocardial necrosis and their clinical implications remain under debate. Our aim was to assess the impact of the universal definition of MI on mortality at 10 years. METHODS AND RESULTS: We studied 676 consecutive patients (Pts) admitted to our intensive cardiac care unit for acute coronary syndrome (ACS) between January 1999 and December 2000. We calculated the relative risk of the total death at 10 years adjusted with the Cox proportional hazards model, between the presence and absence of MI following different definitions: (1), typical symptoms and persistent ST-segment elevation or left bundle branch block (ST-segment elevation definition); (2), typical symptoms and CK-MB activity rise and/or fall >ULN (old definition); and (3), typical symptoms and cTn I rise and/or fall >99th percentile (universal definition). The total mortality at 10 years was 23.8%. The proportion of Pts with AMI was 33.6% for ST-segment elevation definition, 55.8% for old definition, and 70.1% for universal definition. The adjusted hazard ratio of death at 10 years between the presence and absence of AMI was 0.71 (95% confidence interval (CI): 0.46-1.08; P = 0.11) for ST-segment elevation definition, 0.84 (95% CI: 0.55-1.27; P = 0.40) for old definition, and 1.58 (95% CI: 1.07-2.40; P = 0.03) for universal definition. Patients submitted to myocardial revascularization during the initial hospital stay (72%) presented a significantly lower mortality at 10 years, compared with patients not revascularized (adjusted hazard ratio: 0.63, 95% CI: 0.44-0.91; P = 0.014). CONCLUSIONS: In a population with the entire spectrum of ACSs, the universal definition of MI increased this diagnosis by one-quarter and was an independent predictor of mortality at 10 years. Furthermore, myocardial revascularization was associated with a significantly lower mortality at 10 years.
Costa et al. (Mon,) conducted a cohort in Acute coronary syndrome (ACS) (n=676). Universal definition of myocardial infarction vs. Absence of myocardial infarction by universal definition was evaluated on Total mortality at 10 years (HR 1.58, 95% CI 1.07-2.40, p=0.03). Diagnosis of myocardial infarction using the universal definition was an independent predictor of 10-year mortality (HR 1.58; 95% CI 1.07-2.40; P=0.03) in patients with acute coronary syndrome.