Diagnosis of myocardial infarction using the new universal definition: is it enough for risk stratification and guiding decision for revascularization?
Abstract Objectives: Evaluate the new ESC/ACCF/AHA/WHF universal definition of myocardial infarction (MI) in relation to its prognostic implications and the role for guiding decision for revascularization. It was also compared with the multivariable based GRACE Risk Score (GRS).


METHODS
Single centre registry of 389 consecutive patients admitted with non-ST-segment elevation (NSTE) ACS. We calculated the adjusted HR & 95%CI for death/MI at 30-days and one-year follow-up, between the presence or absence of MI using: (1) universal definition: > 99th URL for cTnI (> 0.06 ng/ml) or MBm (> 3.2 ng/ml); (2) MBm > 2 × URL (> 12.2 ng/ml); 3) old WHO: MBact > 2 × URL (> 32U/l). Logistic analysis was performed to test the interaction between tertiles of biomarkers or GRS and the effect of revascularization on the outcome.


RESULTS
The universal definition increased the incidence of MI in 3.5-fold for cTnI, but was not an independent predictor of outcome. The GRS was the only independent predictor of prognosis at 30-days and one-year. The interaction with the prognostic impact of revascularization was only present for the GRS categorized by tertiles.


CONCLUSIONS
In a contemporary unselected population with NSTE-ACS, the universal definition of MI alone was not adequate for risk assessment and revascularization decision making. These purposes were fully addressed with the GRS.
Calé
Rita
R
Hospital Santa Cruz, CHLO, Cardiology, Lisbon, Portugal. ritacale@hotmail.com
Ferreira
Jorge
J
Aguiar
Carlos
C
Santos
Nuno
N
Carmo
Pedro
P
Figueira
João
J
Raposo
Luis
L
Gonçalves
Pedro
P
Silva
José Aniceto
JA
D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis; D000368:Aged; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood*; D019468:Disease Management; D005260:Female; D006801:Humans; D008163:Luminescent Measurements; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D009204:Myocardial Revascularization / Q000009:adverse effects; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D020107:Troponin T; D052279:Creatine Kinase, MB Form