Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

The New Definition of Myocardial Infarction

The New Definition of Myocardial Infarction In their article, Meier et al1 did not find any statistically significant differences in mortality between the group of patients diagnosed using the older World Health Organization criteria for acute myocardial infarction that relies on history, creatine kinase enzyme level, and/or electrocardiographic changes and the group diagnosed using the newer European Society of Cardiology and the American College of Cardiology criteria that incorporates troponins. However, they did find statistically significant differences in the treatment of these 2 groups of patients, with the former group receiving more aggressive in-hospital management that included the use of transcatheter interventions, heparin, and glycoprotein IIb-IIIa inhibitors. Another strategy that has emerged as important in the management of acute myocardial infarction, which was missing in the analysis by Meier et al, is the use of statin drugs. Four observational studies2-5 and 2 randomized trials6,7 have suggested that such a strategy not only improves outcome,2-7 but starting these drug therapies in the acute setting also increases compliance.2,3 It would therefore be interesting to evaluate the rate of statin use between the 2 groups and to determine how these differences might affect the study outcomes. References 1. Meier MAAl-Badr WHCooper JV et al. The new definition of myocardial infarction: diagnostic and prognostic implications in patients with acute coronary syndromes. Arch Intern Med. 2002;1621585- 1589Google ScholarCrossref 2. Fonarow GCGawlinski AMoughrabi STillisch JH Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001;87819- 822Google ScholarCrossref 3. Muhlestein JBHorne BDBair TL et al. Usefulness of in hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reducing mortality. Am J Cardiol. 2001;87257- 261Google ScholarCrossref 4. Aronow HDTopol EJRoe MT et al. Effect of lipid lowering therapy on early mortality after acute coronary syndromes: an observational study. Lancet. 2001;3571063- 1068Google ScholarCrossref 5. Stenestrand UWallentin Lfor the Swedish Register of Cardiac Intensive Care, Early statin treatment following acute myocardial infarction and 1 year survival. JAMA. 2001;285430- 436Google ScholarCrossref 6. Schwartz GGOlsson AGEzekowitz MD et al. The effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001;2851711- 1718Google ScholarCrossref 7. Arntz HAgrawal RWunderlich W et al. Beneficial effects of pravastatin (± cholestyramine/niacin) initiated immediately after a coronary event: the randomized Lipid Coronary Artery Disease (LCAD) study. Am J Cardiol. 2000;861293- 1298Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

The New Definition of Myocardial Infarction

Loading next page...
 
/lp/american-medical-association/the-new-definition-of-myocardial-infarction-R4lftsqxQP
Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.163.2.245
Publisher site
See Article on Publisher Site

Abstract

In their article, Meier et al1 did not find any statistically significant differences in mortality between the group of patients diagnosed using the older World Health Organization criteria for acute myocardial infarction that relies on history, creatine kinase enzyme level, and/or electrocardiographic changes and the group diagnosed using the newer European Society of Cardiology and the American College of Cardiology criteria that incorporates troponins. However, they did find statistically significant differences in the treatment of these 2 groups of patients, with the former group receiving more aggressive in-hospital management that included the use of transcatheter interventions, heparin, and glycoprotein IIb-IIIa inhibitors. Another strategy that has emerged as important in the management of acute myocardial infarction, which was missing in the analysis by Meier et al, is the use of statin drugs. Four observational studies2-5 and 2 randomized trials6,7 have suggested that such a strategy not only improves outcome,2-7 but starting these drug therapies in the acute setting also increases compliance.2,3 It would therefore be interesting to evaluate the rate of statin use between the 2 groups and to determine how these differences might affect the study outcomes. References 1. Meier MAAl-Badr WHCooper JV et al. The new definition of myocardial infarction: diagnostic and prognostic implications in patients with acute coronary syndromes. Arch Intern Med. 2002;1621585- 1589Google ScholarCrossref 2. Fonarow GCGawlinski AMoughrabi STillisch JH Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). Am J Cardiol. 2001;87819- 822Google ScholarCrossref 3. Muhlestein JBHorne BDBair TL et al. Usefulness of in hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reducing mortality. Am J Cardiol. 2001;87257- 261Google ScholarCrossref 4. Aronow HDTopol EJRoe MT et al. Effect of lipid lowering therapy on early mortality after acute coronary syndromes: an observational study. Lancet. 2001;3571063- 1068Google ScholarCrossref 5. Stenestrand UWallentin Lfor the Swedish Register of Cardiac Intensive Care, Early statin treatment following acute myocardial infarction and 1 year survival. JAMA. 2001;285430- 436Google ScholarCrossref 6. Schwartz GGOlsson AGEzekowitz MD et al. The effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001;2851711- 1718Google ScholarCrossref 7. Arntz HAgrawal RWunderlich W et al. Beneficial effects of pravastatin (± cholestyramine/niacin) initiated immediately after a coronary event: the randomized Lipid Coronary Artery Disease (LCAD) study. Am J Cardiol. 2000;861293- 1298Google ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 27, 2003

Keywords: myocardial infarction

References