{"id":31283,"date":"2012-08-25T07:50:31","date_gmt":"2012-08-25T11:50:31","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&p=31283"},"modified":"2012-08-25T07:50:31","modified_gmt":"2012-08-25T11:50:31","slug":"new-universal-definition-of-mi-unveiled-at-esc-2012","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/08\/25\/new-universal-definition-of-mi-unveiled-at-esc-2012\/","title":{"rendered":"New Universal Definition of MI Unveiled at ESC 2012"},"content":{"rendered":"

A new universal definition of myocardial infarction (MI) was unveiled today at the European Society of Cardiology meeting in Munich. The document was developed jointly\u00a0by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), and the World Heart Federation (WHF). It will be published in five journals: the\u00a0European Heart Journal<\/em>,\u00a0the\u00a0Journal of the American College of Cardiology<\/em>,\u00a0Circulation<\/em>,\u00a0Global Heart,\u00a0<\/em>and\u00a0Nature Reviews Cardiology<\/em>. (The document \u00a0was scheduled to go online on Sunday but is now available, along with extensive support material, on\u00a0the American Heart Association website<\/a>.)<\/p>\n

The third universal definition of MI establishes the troponin levels required to make a diagnosis of MI in various situations. In a press release, Kristian Thygesen, the co-chair of the document task force, discussed the difficulties the task force encountered in reaching a consensus. Setting a troponin level for procedure-related MIs is difficult “because interventional cardiologists and surgeons do not want myocardial\u00a0infarction as a complication,\u201d he said. \u201cIt means that they want to set the levels of troponin as high as possible. It was also difficult to reach a consensus because it\u2019s impossible to conduct a clinical trial to find\u00a0the answer.\u201d<\/p>\n

The task force also expects the new definition will be adopted by the FDA and will be used in\u00a0clinical trial\u00a0protocols accepted by the FDA. Said Thygesen, \u201cThis is significant because it will help to standardize the way myocardial infarction is defined in clinical trials, making comparisons between trials\u00a0more meaningful. Steering committees that write protocols for clinical trials do follow FDA requirements.\u201d<\/p>\n

Here is a summary of the new definition from\u00a0an FAQ published by the AHA<\/a>:<\/p>\n

The preferred biomarker overall and for each specific category of MI is cardiac troponin (cTn) (I or T), which has high myocardial tissue specificity as well as high clinical sensitivity. An increased cTn concentration is defined as a value exceeding the 99th percentile of a normal reference population (upper reference limit, URL).<\/p>\n

Myocardial infarction is determined by the specified cTn value, and at least one of the five following diagnostic criteria:<\/p>\n

    \n
  1. Symptoms of ischemia<\/li>\n
  2. New (or presumably new) significant ST\/T-wave changes or LBBB<\/li>\n
  3. Development of pathological Q waves on ECG<\/li>\n
  4. Imaging evidence of new loss of viable myocardium or regional wall-motion abnormality<\/li>\n
  5. Identification of intracoronary thrombus by angiography or autopsy<\/li>\n<\/ol>\n<\/blockquote>\n","protected":false},"excerpt":{"rendered":"

    The new definition specifies the troponin levels required to make a diagnosis of myocardial infarction in various situations.<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20,1,9],"tags":[245,1314],"class_list":["post-31283","post","type-post","status-publish","format-standard","hentry","category-cardiac-surgery","category-general","category-interventional-cardiology","tag-mi","tag-myocardial-infarction"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31283","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=31283"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/31283\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=31283"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=31283"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=31283"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}