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Third universal definition of MI published

Definition will be used to diagnose patients and define endpoints in clinical trials

An updated definition of myocardial infarction was presented at the ESC Congress today by Professor Kristian Thygesen (Denmark), co-chair of the document Task Force. The definition will be used to diagnose patients and define endpoints in clinical trials.

Acute Coronary Syndromes

The document was developed jointly by the European Society of Cardiology (ESC), the American College of Cardiology (ACC), the American Heart Association (AHA) and the World Heart Federation (WHF).

The first joint document in this area was the ESC/ACC criteria for redefinition of myocardial infarction, which was published in 2000. In 2007 the AHA and WHF joined the Task Force and a universal definition was developed.

The 2012 document sets out the levels of troponin required for a diagnosis of procedural related myocardial infarction after percutaneous coronary intervention (PCI), coronary bypass (CABG), other cardiac procedures, and non-cardiac procedures. Troponins are the primary biomarker for identifying if a myocardial infarction has occurred. “This is a controversial area because interventional cardiologists and surgeons do not want myocardial infarction as a complication,” said Professor Thygesen. “It means that they want to set the levels of troponin as high as possible. It was also difficult to reach a consensus because it’s impossible to conduct a clinical trial to find the answer.”

During the development of the third universal definition the Task Force communicated with the US Food and Drug Administration (FDA) and it is anticipated that this definition could be used as the basis for clinical trial protocols designed according to FDA regulations. Professor Thygesen said: “This is significant because it will help to standardize the way myocardial infarction is defined in clinical trials, making comparisons between trials more meaningful. Steering committees that write protocols for clinical trials do follow FDA requirements.”

Troponin levels can also be elevated in myocardial injury and cell death in conditions without overt myocardial ischaemia.
This new document contains a brand new section describing these situations to help clinicians and scientists understand how they differ from myocardial infarction. “This should help clinicians and scientists to make the correct diagnosis,” said Professor Thygesen.

The third universal definition will be published in five journals at about the same time: European Heart Journal on behalf of the ESC, the Journal of the American College of Cardiology for the ACC and Circulation for the AHA. For the first time it will also be published in the World Heart Federation’s Global Heart and Nature Reviews Cardiology.

The ESC is the driving force behind the Task Force, with support from the Committee for Clinical Practice Guidelines and the Practice Guidelines Department. The Task Force was the largest ever, with 52 members, and had a record number of countries involved including newcomers China and Russia.

Professor Thygesen said: “This is a truly global document that will be used worldwide. It will help doctors diagnose their patients so that they can provide the most appropriate treatment, and help researchers design clinical trials with standardized endpoints.”


Thygesen quotes courtesy of CardioPulse – EHJ

Notes to editor

About ACC
The American College of Cardiology is transforming cardiovascular care and improving heart health through continuous quality improvement, patient-centred care, payment innovation and professionalism. The College is a 40,000-member non-profit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online here.

About the American Heart Association
The American Heart Association is devoted to saving people from heart disease and stroke – America’s No. 1 and No. 4 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit or call any of our offices around the country.

About WHF
The World Heart Federation is a nongovernmental organization committed to uniting its members and leads the global fight against heart disease and stroke, with a focus on low-and middle-income countries.

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 75,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

About ESC Congress 2012
ESC Congress 2012 will take place from 25 to 29 August at the Messe München centre in Munich, Germany. Information on the scientific programme is available here. More information on ESC Congress 2012 is available from the ESC Press Office or contact us at