The new definition of myocardial infarction and the impact of troponin determination on clinical practice.
OBJECTIVE
To discuss the more controversial clinical and laboratory aspects in the application of the new biochemical diagnostic standard for myocardial infarction, 4 years after its introduction, and to make some suggestions, which could allow for a more realistic application of the new definition in the current clinical practice.


METHODS
Studies published in the last 4 years in the most important cardiology and laboratory medicine journals (including proceedings of the international meetings), discussing advantages and limits of the new definition of myocardial infarction, were reviewed and pertinent data were discussed and compared with similar information available in literature.


CONCLUSIONS
Although the exact status of implementation of the new definition of myocardial infarction cannot yet be known, the trend toward such recommendation is evolving significantly, even if at different rates in different countries. To make the transition smoother, major educational efforts are required to disseminate the conceptual reasoning behind the new guidelines. On the other hand, more knowledge is needed for some relevant issues, such as the different analytical performance of cardiac troponin assays or the prognostic significance of biomarker changes after a percutaneous coronary intervention.
Panteghini
Mauro
M
Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Cliniche Luigi Sacco, Facoltà di Medicina e Chirurgia--Polo di Vialba, Università degli Studi di Milano, Milano, Italy. mauro.panteghini@unimi.it
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D006331:Heart Diseases / Q000097:blood / Q000175:diagnosis; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T