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July 22, 2002Archives of Internal Medicine

The New Definition of Myocardial Infarction

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Why the study?

Do the new diagnostic criteria for AMI identify a patient population with different outcomes compared to the old criteria?

Population

493 consecutive patients with suspected acute coronary syndromes admitted to University of Michigan, Ann…

Comparison

Diagnosis of acute myocardial infarction by new… vs Diagnosis of AMI by old criteria

Design

Cohort

Follow-up

6 months

Authors

MMMark A. MeierIsalaWAWisam H. Al-BadrSaudi Heart AssociationJCJeanna V. CooperVascular Medicine

Discussion

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Implication

New AMI criteria identify sicker patients with higher unadjusted mortality; leaves open whether criteria independently predict outcomes or should change practice.

Structured PICO

Do the new diagnostic criteria for AMI identify a patient population with different outcomes compared to the old criteria?

P
Population
493 consecutive patients with suspected acute coronary syndromes admitted to University of Michigan, Ann Arbor. Subgroup analyzed: 275 patients with positive cardiac enzymes and symptoms suggestive of coronary ischemia.
I
Intervention
Diagnosis of acute myocardial infarction (AMI) by new criteria (normal peak creatine kinase-MB fraction but elevated troponin I level, n=51)
C
Comparator
Diagnosis of AMI by old criteria (elevated peak creatine kinase-MB fraction and/or new electrocardiographic changes suggestive of AMI regardless of troponin status, n=224)
O
Outcome
In-hospital adverse events (reinfarction, heart failure, shock, and mortality) and 6-month mortalityhard clinical

The new AMI criteria substantially increase AMI diagnoses and identify a cohort with greater comorbidities and worse unadjusted 6-month mortality that would be missed by old criteria.

Limitations

  • Preliminary findings requiring confirmation in additional studies
  • Financial implications of the new criteria are unknown

Cite This Study

Meier et al. (2002) studied this question.

synapsesocial.com/papers/6a7278f9a528af2d65c46ec2https://doi.org/10.1001/archinte.162.14.1585
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Diagnosis of Perioperative Myocardial Infarction with Measurement of Cardiac Troponin I1994 · 537 citations
  2. 2A Comparison of Low-Molecular-Weight Heparin with Unfractionated Heparin for Unstable Coronary Artery Disease1997 · 1,433 citations
  3. 3Myocardial infarction redefined—A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction2000 · 2,284 citations
  4. 4Prognostic Influence of Elevated Values of Cardiac Troponin I in Patients With Unstable Angina1997 · 321 citations
  5. 5Cardiac-Specific Troponin I Levels to Predict the Risk of Mortality in Patients with Acute Coronary Syndromes1996 · 1,772 citations