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Implications of the new definition of myocardial infarction

¹ Dunedin School of Medicine, Dunedin, New Zealand
² Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

Correspondence to:
Correspondence to:
Professor H D White
Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92189, Auckland 1030, New Zealand; harveyw{at}adhb.govt.nz

The new definition of acute myocardial infarction is based primarily on raised troponin levels because of the sensitivity and specificity of these markers and their correlation with the pathophysiology of acute coronary syndromes with plaque fissuring or rupture and embolisation of platelets causing myocyte necrosis. Raised troponin levels are associated with increased risks of death and recurrent myocardial infarction. Greater treatment benefit with low molecular weight heparin, IIb/IIIa antagonists and revascularisation is seen when troponin levels are raised. There are many implications for patients and society of the new definition including changes in insurability and ability to continue certain occupations. Many more patients, who would previously been diagnosed as having unstable angina, will now be diagnosed as having had an acute myocardial infarction. In addition case fatality rates will fall and comparison with previous epidemiological studies using the old definition will be problematic. However, the new definition may result in greater use of evidence based therapies with improved patient outcomes and decreased community death rates.

Abbreviations: MI, myocardial infarction; AMI, acute myocardial infarction; PCI, percutaneous coronary intervention

Keywords: myocardial infarction