New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis
Key result
Diagnosis of myocardial infarction based only on increased troponins was associated with lower 28-day case-fatality (0.2% vs 9.7%) but higher two-year cardiovascular mortality (7.5% vs 3.7%).
Why the study?
Does the 2000 ESC/ACC myocardial infarction definition (adding troponin) alter reported incidence, mortality, and prognosis compared to the 1994 WHO definition in patients aged 35-74?
Population
4,170 consecutive myocardial infarction patients aged 35-74 years from a population-based cohort in Girona…
Comparison
Diagnosis using the 2000 European Society of… vs Diagnosis using the classical World Health…
Design
Cohort
Follow-up
28 days and 2 years
Authors
Discussion
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Member takes
Implication
May identify patients with elevated long-term CV risk despite low short-term fatality; leaves open whether intensified therapy improves outcomes in troponin-only MI.
Study Design
Type
Cohort (n=4,170)
Structured PICO
Does the 2000 ESC/ACC myocardial infarction definition (adding troponin) alter reported incidence, mortality, and prognosis compared to the 1994 WHO definition in patients aged 35-74?
P
Population
4,170 consecutive myocardial infarction patients aged 35-74 years from Girona, Spain, recruited between 2002 and 2009, followed for up to two years.
E
Exposure
Diagnosis using the 2000 European Society of Cardiology/American College of Cardiology definition (which added cardiac troponin as a diagnostic biomarker).
C
Comparator
Diagnosis using the classical World Health Organization definition (1994).
O
Outcome
Myocardial infarction incidence, mortality rates standardized to the European population, and 28-day case-fatality.hard clinical
Main Result
Absolute Event Rate: 7.5% vs 3.7%
Adopting the troponin-based 2000 ESC/ACC MI definition increases reported incidence and lowers short-term case-fatality, but identifies a troponin-only cohort with higher long-term mortality that may be undertreated.
Cite This Study
Agüero et al. (2014) conducted a cohort in myocardial infarction (n=4,170). Diagnosis based only on increased troponins vs. Diagnosis by classical criteria was evaluated on Two-year cardiovascular mortality. Diagnosis of myocardial infarction based only on increased troponins was associated with lower 28-day case-fatality (0.2% vs 9.7%) but higher two-year cardiovascular mortality (7.5% vs 3.7%).