title: Implications of changing definitions of myocardial infarction on number of events and all-cause mortality: the WHO 1979, ESC/ACC 2000, AHA 2003, and Universal 2007 definitions revisited.
abstract: OBJECTIVE
  To analyse the impact of four different definitions of acute myocardial infarction (AMI) on number of events and all-cause mortality after AMI.
  
  
  METHODS
  We retrospectively examined number of AMI events and mortality according to four different definitions of AMI, among 1494 patients admitted to Haukeland University Hospital in Norway from March 2002 to February 2003. Eligible for analysis were 815 patients with a discharge diagnosis of an AMI, and 679 patients without any AMI discharge diagnosis but with elevated cardiac troponin I level during admission.
  
  
  RESULTS
  Applying the WHO 1979 definition resulted in 566 definite AMIs among the 1494 patients and was used as reference. According to the other definitions, there were 455 (-20%) definite AMIs by the original troponin 'rise and fall' version of the ESC/ACC 2000 definition, 729 (+29%) by the troponin 'rise or fall' interpretation of the ESC/ACC 2000 definition, 761 (+34%) by the AHA 2003 definition, and 743 (+31%) by the Universal 2007 definition (all p < 0.001). The 28-day, 1-year, 5-year, and 8-year mortality for definite AMI applying the WHO 1979 definition was 12, 19, 32, and 40%, whereas applying the Universal 2007 definition resulted in a mortality of 14, 21, 35, and 43%, respectively.
  
  
  CONCLUSIONS
  The change of definitions of AMI during the last decades has had a significant impact on the number of AMI events and a moderate impact on the AMI mortality among hospitalized patients.
authors.affiliation: Haukeland University Hospital, Bergen, Norway joerund.langoergen@helse-bergen.no.
authors.forename: Jørund
authors.initials: J
authors.lastname: Langørgen
authors.affiliation: Norwegian Institute of Public Health, Bergen, Norway.
authors.forename: Marta
authors.initials: M
authors.lastname: Ebbing
authors.affiliation: University of Bergen, Norway.
authors.forename: Jannicke
authors.initials: J
authors.lastname: Igland
authors.affiliation: University of Bergen, Norway.
authors.forename: Stein Emil
authors.initials: SE
authors.lastname: Vollset
authors.affiliation: Haukeland University Hospital, Bergen, Norway Institute of Internal Medicine, University of Bergen, Norway.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Nordrehaug
authors.affiliation: University of Bergen, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.affiliation: Haukeland University Hospital, Bergen, Norway Institute of Internal Medicine, University of Bergen, Norway.
authors.forename: Ottar
authors.initials: O
authors.lastname: Nygård
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000145:classification / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D009664:Norway / Q000453:epidemiology; D010343:Patient Admission; D010351:Patient Discharge; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D009626:Terminology as Topic; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D014481:United States; D014944:World Health Organization
chemical_list: D015415:Biomarkers; D019210:Troponin I; D052279:Creatine Kinase, MB Form
keywords: Acute myocardial infarction; CKMB; definition; hospitalized; mortality; number of events; troponin; universal