This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (43)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Cardiovascular System  • Diagnosis  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Diagnostic and Prognostic Implications in Patients With Acute Coronary Syndromes

Mark A. Meier, MD; Wisam H. Al-Badr, MD; Jeanna V. Cooper, MS; Eva M. Kline-Rogers, MS; Dean E. Smith, PhD; Kim A. Eagle, MD; Rajendra H. Mehta, MD, MS

Arch Intern Med. 2002;162:1585-1589.

Background  The clinical implications of the recently revised criteria for diagnosis of acute myocardial infarction (AMI) in patients with suspected acute coronary syndromes are unknown.

Methods  To evaluate the prognostic implications of the new diagnostic criteria for AMI, we studied 493 consecutive patients with suspected acute coronary syndromes admitted to University of Michigan, Ann Arbor, between May 1, 1999, and January 1, 2000. Patients with positive cardiac enzymes and symptoms suggestive of coronary ischemia (n = 275) were divided into 2 groups: group A, with elevated peak creatine kinase–MB fraction and/or new electrocardiographic changes suggestive of AMI regardless of troponin status (diagnosed as AMI by old criteria), and group B, with normal peak creatine kinase–MB fraction but elevated troponin I level (additional patients diagnosed as having AMI by new criteria).

Results  As compared with group A (n = 224), patients in group B (n = 51) were older women, with increased comorbidities such as previous stroke or aortic stenosis, and had fewer in-hospital procedures. In-hospital adverse events (reinfarction, heart failure, shock, and mortality) were similar between the groups, whereas 6-month mortality was higher among group B patients (16.3% vs 5.8%; P = .03). This difference was not statistically significant after adjustment for differences in baseline characteristics between the groups (odds ratio, 1.6; 95% confidence interval, 0.5-5.9).

Conclusions  The new criteria result in a substantial increase in the diagnosis of AMI. Furthermore, they help to identify patients with acute coronary syndromes who have greater comorbidities and worse 6-month outcomes who are otherwise missed by the old criteria. Additional studies are needed to confirm these preliminary findings and to determine the financial implications of the new criteria.

From the Division of Cardiology, Department of Internal Medicine, University of Michigan, Ann Arbor.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

The New Definition of Myocardial Infarction
Carmen E. Guerra and Philippe O. Szapary
Arch Intern Med. 2003;163(2):245.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Requiem for a Heavyweight: The Demise of Creatine Kinase-MB
Saenger and Jaffe
Circulation 2008;118:2200-2206.
FULL TEXT  

The universal definition of myocardial infarction: a consensus document
Alpert et al.
Heart 2008;94:1335-1341.
FULL TEXT  

Impact of New Biomarkers of Myocardial Damage on Trends in Myocardial Infarction Hospital Admission Rates from Population-based Administrative Data
Sanfilippo et al.
Am J Epidemiol 2008;168:225-233.
ABSTRACT | FULL TEXT  

Evolution of the definition of myocardial infarction: what are the implications of a new universal definition?
White
Heart 2008;94:679-684.
FULL TEXT  

Universal Definition of Myocardial Infarction
Thygesen et al.
J Am Coll Cardiol 2007;50:2173-2195.
FULL TEXT  

Universal Definition of Myocardial Infarction
Thygesen et al.
Circulation 2007;116:2634-2653.
FULL TEXT  

Universal definition of myocardial infarction: Kristian Thygesen, Joseph S. Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
Task Force Members et al.
Eur Heart J 2007;28:2525-2538.
FULL TEXT  

STEMI and NSTEMI: are they so different? 1 year outcomes in acute myocardial infarction as defined by the ESC/ACC definition (the OPERA registry)
Montalescot et al.
Eur Heart J 2007;28:1409-1417.
ABSTRACT | FULL TEXT  

Temporal decline in the prognostic impact of a recurrent acute myocardial infarction 1985 to 2002
Buch et al.
Heart 2007;93:210-215.
ABSTRACT | FULL TEXT  

A Call for Universal Definitions in Cardiovascular Disease
Alpert and Thygesen
Circulation 2006;114:757-758.
FULL TEXT  

Redefinition of Myocardial Infarction: Prospective Evaluation in the Community
Roger et al.
Circulation 2006;114:790-797.
ABSTRACT | FULL TEXT  

The British Cardiac Society Working Group definition of myocardial infarction: implications for practice
Das et al.
Heart 2006;92:21-26.
ABSTRACT | FULL TEXT  

Changes in hospitalization rate and mortality after acute myocardial infarction in Denmark after diagnostic criteria and methods changed
Abildstrom et al.
Eur Heart J 2005;26:990-995.
ABSTRACT | FULL TEXT  

Troponin is more useful than creatine kinase in predicting one-year mortality among acute coronary syndrome patients
Yan et al.
Eur Heart J 2004;25:2006-2012.
ABSTRACT | FULL TEXT  

Common Scenarios to Clarify the Interpretation of Cardiac Markers
Ross et al.
JAOA: Journal of the American Osteopathic Association 2004;104:165-176.
ABSTRACT | FULL TEXT  

Rates of Positive Cardiac Troponin I and Creatine Kinase MB Mass among Patients Hospitalized for Suspected Acute Coronary Syndromes
Lin et al.
Clin. Chem. 2004;50:333-338.
ABSTRACT | FULL TEXT  

Case Definitions for Acute Coronary Heart Disease in Epidemiology and Clinical Research Studies: A Statement From the AHA Council on Epidemiology and Prevention; AHA Statistics Committee; World Heart Federation Council on Epidemiology and Prevention; the European Society of Cardiology Working Group on Epidemiology and Prevention; Centers for Disease Control and Prevention; and the National Heart, Lung, and Blood Institute
Luepker et al.
Circulation 2003;108:2543-2549.
FULL TEXT  

Cardiac Troponin I Is Associated With Impaired Hemodynamics, Progressive Left Ventricular Dysfunction, and Increased Mortality Rates in Advanced Heart Failure
Horwich et al.
Circulation 2003;108:833-838.
ABSTRACT | FULL TEXT  

99th Percentile and Analytical Imprecision of Troponin and Creatine Kinase-MB Mass Assays: An Objective Platform for Comparison of Assay Performance
Giannitsis and Katus
Clin. Chem. 2003;49:1248-1249.
FULL TEXT  

Plasma 99th Percentile Reference Limits for Cardiac Troponin and Creatine Kinase MB Mass for Use with European Society of Cardiology/American College of Cardiology Consensus Recommendations
Apple et al.
Clin. Chem. 2003;49:1331-1336.
ABSTRACT | FULL TEXT  

The New Definition of Myocardial Infarction
Guerra and Szapary
Arch Intern Med 2003;163:245-245.
FULL TEXT  

Implications of the New Definition of MI
Journal Watch Cardiology 2002;2002:4-4.
FULL TEXT  

A New Definition of Myocardial Infarction
JWatch Emergency Med. 2002;2002:1-1.
FULL TEXT