Task Force Updates Myocardial Infarction Definition

Developed jointly by the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation, the new document will be used worldwide.

An updated definition of myocardial infarction was presented at the ESC Congress in Munich, Germany on Aug. 25 by Professor Kristian Thygesen, the Danish co-chair of the document's 52-member task force. The definition will be used by physicians worldwide to diagnose patients and define endpoints in clinical trials; it was developed jointly by the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation.

According to AHA, the first joint document in this area was the ESC/ACC criteria for redefinition of myocardial infarction, published in 2000. AHA and WHF joined the fask force five years ago and a universal definition was developed. It establishes the levels of troponin required for a diagnosis of procedural related myocardial infarction after percutaneous coronary intervention, coronary bypass, other cardiac procedures, and non-cardiac procedures; troponins are the primary biomarker for identifying if a myocardial infarction has occurred.

"This is a controversial area because interventional cardiologists and surgeons do not want myocardial infarction as a complication," said Thygesen. "It means that they want to set the levels of troponin as high as possible. It was also difficult to reach a consensus because it's impossible to conduct a clinical trial to find the answer."

AHA said the task force communicated with the U.S. Food and Drug Administration, so the new definition could be used as the basis for clinical trial protocols designed according to FDA regulations. "This is significant," Thygesen said, "because it will help to standardize the way myocardial infarction is defined in clinical trials, making comparisons between trials more meaningful. Steering committees that write protocols for clinical trials do follow FDA requirements."

The definition will be published in five journals at about the same time: European Heart Journal on behalf of the ESC, the Journal of the American College of Cardiology for the ACC and Circulation for the AHA, and the World Heart Federation's Global Heart and Nature Reviews Cardiology.

"This is a truly global document that will be used worldwide," said Thygesen. "It will help doctors diagnose their patients so that they can provide the most appropriate treatment and help researchers design clinical trials with standardized endpoints."

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