Guidelines: The ESC/ACC/AHA/WHF Global Task Force Releases New Universal Definition of MI

October 19, 2007 By Scott P. Williams [mailto:swilliams@perfuse.org]

Sophia Antipolis, France: The much anticipated new universal definition of myocardial infarction (MI) was unveiled today. The definition is scheduled to be published concurrently in the European Heart Journal and the Journal of American College of Cardiology.

The new definition is a revision of the ESC/ACC Task Force’s 2000 consensus document outlining the criteria for diagnosing MI. The definition is the product of a collaborative effort by a Global Task Force, composed of leaders from the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA), and the World Heart Federation (WHF). The members of the Global Task Force represented experts from the fields of biomarkers, ECG, imaging, interventions, clinical investigations, public policy, and implementation.

According to and ESC press release the 2000 ESC/ACC Task Force’s definition suggested that “MI be qualified by reference to the amount of heart muscle loss (infarct size), to the circumstances leading to the infarct (e.g. spontaneous or procedure related) and to the timing of the heart muscle cell death relative to the time of the observation (evolving, healing, or healed myocardial infarction).” The updated definition builds upon these criteria by adding ECG criteria and imagingmodalities. Further, the majority of the Global Task Force’s members concluded that small elevations in blood troponin levels following PCI should be identified as true infarcts. The task force did designate, though, that these procedure related infarcts need to be classified separately from spontaneous MI.

According the ESC press release “the original (2000) troponin-based definition of MI is still not accepted and applied by many clinicians” which has led to “continuing confusion surrounding the diagnosis for many patients.” Due to this lack of acceptance there is currently a large number of underserved patients, mainly older women, whom suffer small infarcts that can only be identified through precise troponin measurements. This set of patients should greatly benefit from a widespread adoption of the revised definition of MI, as they could be better identified and appropriately treated.

An additional benefit of the acceptance of the Global Task Force’s definition should be further standardization of the results of clinical trials. A greater number of comparisons between various pharmacologic, interventional, and epidemiological studies can be appropriately and accurately made as the clinicians and the clinical scientists, begin to identify and diagnose MI in a more uniform manner.

The Global Task Force’s members hope that the standardization provided by the new definition of MI will benefit patients, physicians, clinical investigators, and epidemiologists worldwide, and act as the impetus for further standardization of all cardiovascular diseases.

References

1.)The European Society of Cardiology (ESC), www.escardio.org

2.)The American Heart Association (AHA), www.americanheart.org

3.)The American College of Cardiology (ACC), www.acc.org