September 1, 2000Journal of the American College of Cardiology
Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction
Key Points
- The document aims to clarify the criteria used for diagnosing acute and established myocardial infarction (MI).
- Consensus document from The Joint European Society of Cardiology/American College of Cardiology committee.
- Criteria for acute, evolving, and established MI include biochemical markers and ECG findings.
- Focus on ischemic symptoms, pathologic changes, and interventions for diagnosis.
- Diagnosis of acute MI requires elevation of cardiac biomarkers (e.g., troponin) with ischemic signs.
- Established MI can be identified by new pathologic Q waves on ECG over time.
- Normalizing cardiac biomarkers may occur in cases of established MI.
PICO
P
Population
Myocardial infarction
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
RMRajendra MehtaClinical assistant professor of cardiology, University of Michigan
“In the United States, nearly a million heart attacks are diagnosed annually. These data suggest that under the new criteria, 250,000 more will be diagnosed each year. These myocardial infarctions would have been missed by the old criteria.”
“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.”
JAJoseph AlpertProfessor of medicine, University of Arizona
“The task force that prepared this revision is convinced that it will aid clinicians and clinical scientists in standardizing the diagnosis of acute MI.”
Implication
This consensus document established the modern definition of myocardial infarction, heavily incorporating the use of troponin as a primary biomarker alongside clinical and ECG criteria.
Abstract
Definition of MI. Criteria for acute, evolving or recent MI. Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI: 1) Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following: a) ischemic symptoms; b) development of pathologic Qwaves on the ECG; c) ECG changes indicative of ischemia (ST segment elevation or depression); or d) coronary artery intervention (e.g., coronary angioplasty). 2) Pathologic findings of an acute MI. Criteria for established MI. Any one of the following criteria satisfies the diagnosis for established MI: 1) Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed. 2) Pathologic findings of a healed or healing MI.
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Cite This Study
Antman et al. (2000) conducted a review in Myocardial infarction. The joint ESC/ACC consensus document redefined myocardial infarction to require a typical rise and fall of biochemical markers (troponin or CK-MB) along with ischemic symptoms or ECG changes.