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Gaetano A. Lanza, The universal definition of myocardial infarction: some issues and concerns, European Heart Journal, Volume 29, Issue 9, May 2008, Page 1209, https://doi.org/10.1093/eurheartj/ehn130
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Extract
The ESC/ACC/AHA/WHF Task Force for the redefinition of myocardial infarction (MI) made an outstanding work to achieve a ‘universal’ definition of MI.1 Some points, however, do not seem fully coherent or clear and would probably deserve further considerations by the authors.
Finally, using any increase of biomarkers to diagnose MI seems a questionable choice. It is now clear that small elevations in troponins may occur even for mild/short episodes of myocardial ischaemia. Thus, the new criteria will lead to a dramatic increase of acute MI diagnoses. The authors state that this is helpful, as MI diagnosis would allow appropriate secondary prevention. However, the detection of an acute ischaemic episode would in any case lead to adequate prevention, even if diagnosis is not ‘acute MI’. Perhaps, a diagnosis of ‘acute MI’ only when cardiospecific biomarkers peak higher than reasonable cut-off levels, suggesting a significant loss of myocardial tissue, can be more appropriate. This would be nearer to the original anatomo-pathological concept of ‘infarction’ and avoid most of the previous issues and concerns.
