A new definition for acute myocardial infarction

The recently introduced cardiac troponins are highly sensitive and specific markers for myocardial cell necrosis. The availability of these markers required a change in the classical definition of acute myocardial infarction. This definition of acute myocardial infarction, issued in 2000 by the American College of Cardiology and the European Society of Cardiology, requires elevation of cardiac biomarkers (preferably troponins). The new definition has multiple medical, epidemiological, social, occupational and other implications. As many as 30% of patients previously diagnosed with unstable angina now receive the diagnosis of myocardial infarction. These additional patients change the epidemiology of acute myocardial infarction. New approaches to issues of insurance and employment following myocardial infarction are necessary following the introduction of the new definition. A few aspects of the new definition of myocardial infarction remain controversial, especially those regarding mild myocardial damage following percutaneous coronary intervention. The Israel Heart Society has recently joined other such Societies in the world and endorsed the new definition. While some further refinement of the definition is probably required, we believe it is the best tool available today for the working diagnosis of myocardial infarction and call upon physicians to learn it and use it on a routine basis.