Moving toward a new definition of acute myocardial infarction for the 21st century: status of the ESC/ACC consensus conference. European Society of Cardiology and American College of Cardiology

Abstract

The European Society of Cardiology and American College of Cardiology established their initial Joint Consensus Conference in July 1999 to develop a new definition of Acute Myocardial Infarction. This action was deemed necessary because of the development of new sensitive biochemical markers of myocardial necroses: Troponins T and I. There were 5 working groups, including one in Electrocardiography. The Conference adopted a definition that required only a history of "ischemic symptoms" and "a typical rise and fall" of at least one of the biochemical markers. The ECG Working Group strongly advised that a term distinctive from "myocardial infarction" such as "myocardial necrosette" be adopted as the diagnosis for an acute coronary event during which the peak biochemical marker level is below that which occurs when serial evolutionary ECG changes are observed. A pilot substudy from the GUSTO IIa Clinical Trial has identified the low end of the "ECG Change Range" to be: >2x the upper limit of normal for CK-MB, > 11 x for Troponin T, and >6 x for Troponin I.