title: New myocardial infarction definition affects incidence, mortality, hospitalization rates and prognosis.
abstract: OBJECTIVE
  To analyse differences in myocardial infarction incidence, mortality and hospitalization rates, 28-day case-fatality and two-year prognosis using two myocardial infarction case definitions: the classical World Health Organization definition (1994) and the European Society of Cardiology/American College of Cardiology definition (2000), which added cardiac troponin as a diagnostic biomarker.
  
  
  METHODS
  Population-based cohort of 4170 consecutive myocardial infarction patients aged 35-74 years from Girona (Spain) recruited between 2002 and 2009.
  
  
  METHODS
  Incidence, mortality rates standardized to the European population and 28-day case-fatality were calculated. To estimate the association between case definition and prognosis, Cox models were fitted.
  
  
  RESULTS
  Use of the 2000 European Society of Cardiology/American College of Cardiology definition significantly increased myocardial infarction incidence per 100,000 population (238.3 vs. 274.5 in men and 54.1 vs. 69.7 in women). Applying this definition decreased the 28-day case-fatality rate from 26.9% to 23.4% in men, and from 31.0% to 24.1% in women. In the acute phase, patients diagnosed only by increased troponins were significantly less treated with thrombolysis (34.4% vs. 2.0%), angiotensin-converting enzyme inhibitors (71.7% vs. 65.0%) and percutaneous coronary intervention (41.1% vs. 31.7%). Case-fatality at 28 days was significantly better in cases diagnosed only by troponin increase (0.2 % vs. 9.7%), but two-year cardiovascular mortality was higher (7.5% vs. 3.7%).
  
  
  CONCLUSIONS
  Inclusion of cardiac troponins in myocardial infarction diagnosis increased annual incidence and decreased case-fatality. Diagnosis based only on increased troponins was associated with worse outcome. This group of patients at high risk of death should receive aggressive secondary prevention therapy.
authors.affiliation: Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Infectious Diseases Service, Hospital Clinic - IDIBAPS, University of Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Agüero
authors.affiliation: Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
authors.affiliation: Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Elosua
authors.affiliation: Cardiology Unit, University Hospital Josep Trueta, Girona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Sala
authors.affiliation: Cardiology Unit, University Hospital Josep Trueta, Girona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Masiá
authors.affiliation: Research Unit of Family Medicine Girona, Primary Care Research Institute Jordi Gol, Spain.
authors.forename: Rafel
authors.initials: R
authors.lastname: Ramos
authors.affiliation: Cardiovascular Epidemiology and Genetics, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain mgrau@imim.es.
authors.forename: María
authors.initials: M
authors.lastname: Grau
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D013030:Spain / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D015854:Up-Regulation
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D014336:Troponin
keywords: Cohort studies; coronary disease; epidemiology; incidence; mortality; myocardial infarction