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New definition of myocardial infarction : impact on long-term mortality

Hochholzer, Willibald and Buettner, Heinz J. and Trenk, Dietmar and Laule, Kirsten and Christ, Michael and Neumann, Franz-Josef and Mueller, Christian. (2008) New definition of myocardial infarction : impact on long-term mortality. The American journal of medicine, Vol. 121, H. 5. pp. 399-405.

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Official URL: http://edoc.unibas.ch/dok/A6003898

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Abstract

BACKGROUND: The use of cardiac troponin allows the identification of additional patients developing myocardial necrosis during an acute coronary syndrome. Novel guidelines of European and American cardiac societies recommend labeling these events as myocardial infarction. Our study evaluated the long-term mortality in the group of patients with non-ST segment elevation myocardial infarction not meeting the older World Health Organization (WHO) criteria (creatine phosphokinase) but additionally identified by the novel definition of myocardial infarction. METHODS: This cohort study included 1024 consecutive patients with non-ST segment elevation acute coronary syndrome classified into "unstable angina," myocardial infarction according to the WHO definition ("WHO criteria"), and myocardial infarction additionally identified by the novel definition ("additional criteria"). All patients were treated with an early invasive strategy. The primary end point was all-cause mortality during follow-up of up to 36 months. RESULTS: During long-term follow-up (median 16 months, interquartile range 6-29 months), 67 deaths occurred. Kaplan-Meier analysis showed cumulative 3-year mortality rates of 5.6% in patients with "unstable angina," 9.1% in patients identified by "WHO criteria," and 17.5% in patients identified by "additional criteria" (P >.001). Cox regression analysis confirmed the "additional criteria" as a significant predictor of mortality (hazard ratio 3.1; 95% confidence interval, 1.9-5.0; P >.001). CONCLUSIONS: The new definition of myocardial infarction based on cardiac troponin testing identifies a high-risk group of additional patients with acute coronary syndrome that is, therefore, appropriately classified as myocardial infarction. In fact, long-term mortality in "additional criteria" patients is higher than in "WHO criteria" patients.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Stationäre innere Medizin (Schifferli)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Ehemalige Einheiten Medizinische Fächer (Klinik) > Stationäre innere Medizin (Schifferli)
UniBasel Contributors:Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Excerpta Medica
ISSN:0002-9343
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:23 May 2014 08:33
Deposited On:23 May 2014 08:33

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