title: Can we monitor heart attack in the troponin era? Evidence from a population-based cohort study.
abstract: BACKGROUND
  Troponins (highly sensitive biomarkers of myocardial damage) increase counts of myocardial infarction (MI) in clinical practice, but their impact on trends in admission rates for MI in National statistics is uncertain.
  
  
  METHODS
  Cases coded as MI or other cardiac diagnoses in the Hospital Morbidity Data Collection (MI-HMDC) in Western Australia in 1998 and 2003 were classified using revised criteria for MI developed by an International panel convened by the American Heart Association (AHA criteria) using information on symptoms, ECGs and cardiac biomarkers abstracted from samples of medical notes. Age-sex standardized rates of MI-HMDC were compared with rates of MI based on AHA criteria including troponins (MI-AHA) or traditional biomarkers only (MI-AHAck).
  
  
  RESULTS
  Between 1998 and 2003, rates of MI-HMDC decreased by 3.5% whereas rates of MI-AHA increased by 17%, a difference largely due to increased false-negative cases in the HMDC associated with marked increased use of troponin tests in cardiac admissions generally, and progressively lower test thresholds. In contrast, rates of MI-AHAck declined by 18%.
  
  
  CONCLUSIONS
  Increasing misclassification of MI-AHA by the HMDC may be due to reluctance by clinicians to diagnose MI based on relatively small increases in troponin levels. These influences are likely to continue. Monitoring MI using AHA criteria will require calibration of commercially available troponin tests and agreement on lower diagnostic thresholds for epidemiological studies. Declining rates of MI-AHA ck are consistent with long-standing trends in MI in Western Australia, suggesting that neither MI-HMDC nor MI-AHA reflect the true underlying population trends in MI.
authors.affiliation: School of Population Health M431, University of Western Australia, 35 Stirling Highway, Crawley 6009 WA, Australia. frank.sanfilippo@uwa.edu.au
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Ridout
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Bradshaw
authors.forename: Judith C
authors.initials: JC
authors.lastname: Finn
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rankin
authors.forename: Peter C
authors.initials: PC
authors.lastname: Sprivulis
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004562:Electrocardiography / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D011159:Population Surveillance / Q000379:methods; D014336:Troponin / Q000097:blood*; D014904:Western Australia / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D014336:Troponin