Redefinition of myocardial infarction: Prospective evaluation in the community

Veronique Lee Roger, Jill M. Killian, Susan A. Weston, Allan S Jaffe, Jan Kors, Paula J. Santrach, Hugh Tunstall-Pedoe, Steven J. Jacobsen

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

BACKGROUND - The 2000 European Society of Cardiology/American College of Cardiology definition for myocardial infarction (MI) combines ischemic symptoms, electrocardiographic changes, and troponin rather than creatine kinase levels. The use of troponins will increase the detection of MI by a magnitude to be quantified, and the clinical acceptance of the new definition is unknown. METHOD AND RESULTS - Subjects presenting to an Olmsted County facility with a troponin T value ≥0.03 ng/mL between November 2002 and March 2005 were prospectively classified through the use of standardized MI criteria, relying on cardiac pain, Minnesota coding of the ECG, and troponin, creatine kinase, and its MB fraction measured simultaneously. Through the use of dynamic changes in troponin, 538 MIs were identified versus 327 with creatine kinase and 427 with only the MB fraction of creatine kinase. This represents a 74% (95% confidence interval [CI], 69% to 79%) increase above the number of MIs identified with creatine kinase and a 41% (95% CI, 37% to 46%) increase above the number identified with criteria including only its MB fraction. When relying on single values of troponin, increases in the number of MIs were always large but varied widely according to the threshold used for troponin. Cases meeting only troponin-based criteria were less likely to have electrocardiographic ST-segment elevation and had better survival than those identified with previous criteria. Clinician diagnoses mentioned MI in 42% (95% CI, 34% to 49%) of cases meeting only troponin-based criteria versus 74% (95% CI, 69% to 78%) for MIs meeting the previous criteria (P<0.001). CONCLUSIONS - The prospective application of the new criteria in the community results in a large increase in the number of MIs and a change in case mix. The clinical acceptance of the new criteria is incomplete, and studies that rely exclusively on dismissal diagnoses to assess MI rates may underestimate the burden of disease as presently defined.

Original languageEnglish (US)
Pages (from-to)790-797
Number of pages8
JournalCirculation
Volume114
Issue number8
DOIs
StatePublished - Aug 2006

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Troponin
Myocardial Infarction
Creatine Kinase
Confidence Intervals
MB Form Creatine Kinase
Troponin T
Diagnosis-Related Groups
Electrocardiography
Pain

Keywords

  • Biomarkers
  • Criteria
  • Diagnosis
  • Myocardial infarction

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Redefinition of myocardial infarction : Prospective evaluation in the community. / Roger, Veronique Lee; Killian, Jill M.; Weston, Susan A.; Jaffe, Allan S; Kors, Jan; Santrach, Paula J.; Tunstall-Pedoe, Hugh; Jacobsen, Steven J.

In: Circulation, Vol. 114, No. 8, 08.2006, p. 790-797.

Research output: Contribution to journalArticle

Roger, VL, Killian, JM, Weston, SA, Jaffe, AS, Kors, J, Santrach, PJ, Tunstall-Pedoe, H & Jacobsen, SJ 2006, 'Redefinition of myocardial infarction: Prospective evaluation in the community', Circulation, vol. 114, no. 8, pp. 790-797. https://doi.org/10.1161/CIRCULATIONAHA.106.627505
Roger, Veronique Lee ; Killian, Jill M. ; Weston, Susan A. ; Jaffe, Allan S ; Kors, Jan ; Santrach, Paula J. ; Tunstall-Pedoe, Hugh ; Jacobsen, Steven J. / Redefinition of myocardial infarction : Prospective evaluation in the community. In: Circulation. 2006 ; Vol. 114, No. 8. pp. 790-797.
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abstract = "BACKGROUND - The 2000 European Society of Cardiology/American College of Cardiology definition for myocardial infarction (MI) combines ischemic symptoms, electrocardiographic changes, and troponin rather than creatine kinase levels. The use of troponins will increase the detection of MI by a magnitude to be quantified, and the clinical acceptance of the new definition is unknown. METHOD AND RESULTS - Subjects presenting to an Olmsted County facility with a troponin T value ≥0.03 ng/mL between November 2002 and March 2005 were prospectively classified through the use of standardized MI criteria, relying on cardiac pain, Minnesota coding of the ECG, and troponin, creatine kinase, and its MB fraction measured simultaneously. Through the use of dynamic changes in troponin, 538 MIs were identified versus 327 with creatine kinase and 427 with only the MB fraction of creatine kinase. This represents a 74{\%} (95{\%} confidence interval [CI], 69{\%} to 79{\%}) increase above the number of MIs identified with creatine kinase and a 41{\%} (95{\%} CI, 37{\%} to 46{\%}) increase above the number identified with criteria including only its MB fraction. When relying on single values of troponin, increases in the number of MIs were always large but varied widely according to the threshold used for troponin. Cases meeting only troponin-based criteria were less likely to have electrocardiographic ST-segment elevation and had better survival than those identified with previous criteria. Clinician diagnoses mentioned MI in 42{\%} (95{\%} CI, 34{\%} to 49{\%}) of cases meeting only troponin-based criteria versus 74{\%} (95{\%} CI, 69{\%} to 78{\%}) for MIs meeting the previous criteria (P<0.001). CONCLUSIONS - The prospective application of the new criteria in the community results in a large increase in the number of MIs and a change in case mix. The clinical acceptance of the new criteria is incomplete, and studies that rely exclusively on dismissal diagnoses to assess MI rates may underestimate the burden of disease as presently defined.",
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T2 - Prospective evaluation in the community

AU - Roger, Veronique Lee

AU - Killian, Jill M.

AU - Weston, Susan A.

AU - Jaffe, Allan S

AU - Kors, Jan

AU - Santrach, Paula J.

AU - Tunstall-Pedoe, Hugh

AU - Jacobsen, Steven J.

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N2 - BACKGROUND - The 2000 European Society of Cardiology/American College of Cardiology definition for myocardial infarction (MI) combines ischemic symptoms, electrocardiographic changes, and troponin rather than creatine kinase levels. The use of troponins will increase the detection of MI by a magnitude to be quantified, and the clinical acceptance of the new definition is unknown. METHOD AND RESULTS - Subjects presenting to an Olmsted County facility with a troponin T value ≥0.03 ng/mL between November 2002 and March 2005 were prospectively classified through the use of standardized MI criteria, relying on cardiac pain, Minnesota coding of the ECG, and troponin, creatine kinase, and its MB fraction measured simultaneously. Through the use of dynamic changes in troponin, 538 MIs were identified versus 327 with creatine kinase and 427 with only the MB fraction of creatine kinase. This represents a 74% (95% confidence interval [CI], 69% to 79%) increase above the number of MIs identified with creatine kinase and a 41% (95% CI, 37% to 46%) increase above the number identified with criteria including only its MB fraction. When relying on single values of troponin, increases in the number of MIs were always large but varied widely according to the threshold used for troponin. Cases meeting only troponin-based criteria were less likely to have electrocardiographic ST-segment elevation and had better survival than those identified with previous criteria. Clinician diagnoses mentioned MI in 42% (95% CI, 34% to 49%) of cases meeting only troponin-based criteria versus 74% (95% CI, 69% to 78%) for MIs meeting the previous criteria (P<0.001). CONCLUSIONS - The prospective application of the new criteria in the community results in a large increase in the number of MIs and a change in case mix. The clinical acceptance of the new criteria is incomplete, and studies that rely exclusively on dismissal diagnoses to assess MI rates may underestimate the burden of disease as presently defined.

AB - BACKGROUND - The 2000 European Society of Cardiology/American College of Cardiology definition for myocardial infarction (MI) combines ischemic symptoms, electrocardiographic changes, and troponin rather than creatine kinase levels. The use of troponins will increase the detection of MI by a magnitude to be quantified, and the clinical acceptance of the new definition is unknown. METHOD AND RESULTS - Subjects presenting to an Olmsted County facility with a troponin T value ≥0.03 ng/mL between November 2002 and March 2005 were prospectively classified through the use of standardized MI criteria, relying on cardiac pain, Minnesota coding of the ECG, and troponin, creatine kinase, and its MB fraction measured simultaneously. Through the use of dynamic changes in troponin, 538 MIs were identified versus 327 with creatine kinase and 427 with only the MB fraction of creatine kinase. This represents a 74% (95% confidence interval [CI], 69% to 79%) increase above the number of MIs identified with creatine kinase and a 41% (95% CI, 37% to 46%) increase above the number identified with criteria including only its MB fraction. When relying on single values of troponin, increases in the number of MIs were always large but varied widely according to the threshold used for troponin. Cases meeting only troponin-based criteria were less likely to have electrocardiographic ST-segment elevation and had better survival than those identified with previous criteria. Clinician diagnoses mentioned MI in 42% (95% CI, 34% to 49%) of cases meeting only troponin-based criteria versus 74% (95% CI, 69% to 78%) for MIs meeting the previous criteria (P<0.001). CONCLUSIONS - The prospective application of the new criteria in the community results in a large increase in the number of MIs and a change in case mix. The clinical acceptance of the new criteria is incomplete, and studies that rely exclusively on dismissal diagnoses to assess MI rates may underestimate the burden of disease as presently defined.

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KW - Diagnosis

KW - Myocardial infarction

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