The new and old definitions of acute myocardial infarction: a data-based comparison

Nagurney, John Tobias; Huang, Calvin; Heredia, Orlando; Sane, Swati; Lewis, Sarah C.; Chang, Yuchiao; Jang, Ik-Kyung

doi:10.1016/j.ajem.2007.08.001

« Previous Next »American Journal of Emergency Medicine
Volume 26, Issue 5 , Pages 523-531, June 2008

The new and old definitions of acute myocardial infarction: a data-based comparison☆

John Tobias Nagurney, MD, MPH
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
- Corresponding author. Tel.: +1 617 726 7623; fax: +1 617 724 0917.
Calvin Huang, BA
- Tufts University School of Medicine, Boston, MA 02111 and Harvard Affiliated Emergency Medicine Residency, Boston, MA 02115
Orlando Heredia, MBBS
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
Swati Sane, MBBS, MPH
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
Sarah C. Lewis
- Stanford University, Palo Alto, CA 94305, USA
Yuchiao Chang, PhD
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
Ik-Kyung Jang, MD, PhD
- Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA

Received 18 January 2007; received in revised form 22 June 2007; accepted 2 August 2007.

Abstract

Purpose

To measure the agreement between the newer European Society of Cardiology–American College of Cardiology (ESC-ACC) definition of acute myocardial infarction (AMI) and the traditional definition established by the World Health Organization (WHO).

Basic Procedures

All adult ED patients admitted to our institution with at least one abnormally elevated cardiac biomarker were determined to have had an AMI by either or both definitions. The degree of agreement and the frequency of the reasons for disagreement between these 2 definitions were measured.

Main Findings

A final study population consisted of 339 patients; 196 (58%) had an AMI by one or both definitions. Among them, 126 (64%; 95% confidence interval [CI], 57-71) were discordant for these 2 definitions: 104 (53%; 95% CI, 46-60) met only the ESC-ACC, whereas 22 (11%; 95% CI, 6-16) met only the WHO definition. Among those who met only the ESC-ACC definition, 37 (36%; 95% CI, 27-45) met none of the 3 traditional WHO criteria.

Principal Conclusions

More patients are discordant than concordant for the 2 standard definitions of AMI. Among them, a large majority meet only the new ESC-ACC definition.