scholarly journals The Third Universal Definition of Myocardial Infarction—Moving Forward

2012 ◽  
Vol 58 (12) ◽  
pp. 1727-1728 ◽  
Author(s):  
Allan S Jaffe ◽  
Fred S Apple
Keyword(s):  
Myocardial Infarction ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

scholarly journals Global Adoption of High-Sensitivity Cardiac Troponins and the Universal Definition of Myocardial Infarction

2018 ◽  
Author(s):  
Atul Anand ◽  
Anoop SV Shah ◽  
Agim Beshiri ◽  
Allan S Jaffe ◽  
Nicholas L Mills
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
Diagnosis And Management ◽  
Coronary Syndrome ◽  
The Third ◽  
Diagnostic Threshold ◽  
Serial Sampling ◽  
Universal Definition ◽  
Definition Of

AbstractImportanceThe third Universal Definition of Myocardial Infarction aimed to standardize the approach to the diagnosis and management of myocardial infarction. High-sensitivity cardiac troponin testing was recommended, as these assays have improved precision at low concentrations, but concerns over specificity may have limited implementation.ObjectiveTo determine the global adoption of high-sensitivity cardiac troponin assays and key recommendations from the Universal Definition.Design, Setting and ParticipantsGlobal survey of 1,902 medical centers across 23 countries evenly distributed across all five continents. Included respondents were involved in the diagnosis and management of patients with suspected acute coronary syndrome at their institutions.Main Outcomes and MeasuresStructured questionnaire detailing the primary biomarker used for myocardial infarction, diagnostic thresholds and critical elements of clinical pathways for comparison to the third Universal Definition recommendations.ResultsCardiac troponin was the primary diagnostic biomarker for myocardial infarction at 96% of all sites surveyed. Only 41% of centers had adopted high-sensitivity cardiac troponin assays, with wide variation from 7% in North America to 60% in Europe. Sites using high-sensitivity assays more frequently employed serial sampling pathways (91% vs. 78%) and the 99th percentile diagnostic threshold (74% vs. 66%) when compared to sites using the previous generation of troponin assays. Furthermore, sites using high-sensitivity assays more often used earlier serial sampling (≤3 hours) and accelerated diagnostic pathways. However, fewer than 1 in 5 sites using high-sensitivity assays had adopted sex-specific thresholds (18%).Conclusions and RelevanceProgress has been made in adopting the recommendations of the Universal Definition of Myocardial Infarction, particularly in the use of the 99th percentile diagnostic threshold and serial sampling. However, high-sensitivity assays are used in a minority of sites and sex-specific thresholds in even fewer. These findings highlight regions where additional efforts are required to improve the risk stratification and diagnosis of patients with myocardial infarction.

Republished: Clinical implications of the Third Universal Definition of Myocardial Infarction

2014 ◽  
Vol 90 (1067) ◽  
pp. 502-510 ◽  
Author(s):  
Harvey D White ◽  
Kristian Thygesen ◽  
Joseph S Alpert ◽  
Allan S Jaffe
Keyword(s):  
Myocardial Infarction ◽  
Clinical Implications ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

scholarly journals Diagnosis of Type 1 and Type 2 Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay with Sex-Specific 99th Percentiles Based on the Third Universal Definition of Myocardial Infarction Classification System

2015 ◽  
Vol 61 (4) ◽  
pp. 657-663 ◽  
Author(s):  
Yader Sandoval ◽  
Stephen W Smith ◽  
Karen M Schulz ◽  
MaryAnn M Murakami ◽  
Sara A Love ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Classification System ◽  
Cardiac Troponin ◽  
Troponin I ◽  
High Sensitivity ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

Abstract BACKGROUND The frequency and characteristics of myocardial infarction (MI) subtypes per the Third Universal Definition of MI (TUDMI) classification system using high-sensitivity (hs) cardiac troponin assays with sex-specific cutoffs is not well known. We sought to describe the diagnostic characteristics of type 1 (T1MI) and type 2 (T2MI) MI using an hs–cardiac troponin I (hs-cTnI) assay with sex-specific cutoffs. METHODS A total of 310 consecutive patients with serial cTnI measurements obtained on clinical indication were studied with contemporary and hs-cTnI assays. Ninety-ninth percentile sex-specific upper reference limits (URLs) for the hs-cTnI assay were 16 ng/L for females and 34 ng/L for males. The TUDMI consensus recommendations were used to define and adjudicate MI based on each URL. RESULTS A total of 127 (41%) patients had at least 1 hs-cTnI exceeding the sex-specific 99th percentiles, whereas 183 (59%) had hs-cTnI within the reference interval. Females had more myocardial injury related to supply/demand ischemia than males (39% vs 18%, P = 0.01), whereas males had more multifactorial or indeterminate injury (52% vs 33%, P = 0.05). By hs-cTnI, there were 32 (10%) acute MIs, among which 10 (3%) were T1MI and 22 (7%) were T2MI. T2MI represented 69% (22 out of 32) of all acute MIs, whereas T1MI represented 31% (10 out of 32). Ninety-five patients (31%) had an increased hs-cTnI above the 99th percentile but did not meet criteria for acute MI. The most common triggers for T2MI were tachyarrhythmias, hypotension/shock, and hypertension. By contemporary cTnI, more MIs (14 T1MI and 29 T2MI) were diagnosed. By contemporary cTnI, there were 43 MIs, 14 T1MI, and 29 T2MI. CONCLUSIONS Fewer MI diagnoses were found with the hs-cTnI assay, contrary to the commonly accepted idea that hs-cTnI will lead to excessive false-positive diagnoses.

scholarly journals Value of the SYNTAX score for periprocedural myocardial infarction according to WHO and the third universal definition of myocardial infarction: insights from the TWENTE trial

2016 ◽  
Vol 12 (4) ◽  
pp. 431-440 ◽  
Author(s):  
Kenneth Tandjung ◽  
Ming Kai Lam ◽  
Hanim Sen ◽  
Frits H.A.F. de Man ◽  
J. (Hans) W. Louwerenburg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Syntax Score ◽  
The Third ◽  
Periprocedural Myocardial Infarction ◽  
Universal Definition ◽  
Definition Of

scholarly journals Interphysician agreement on subclassification of myocardial infarction

Heart ◽  
2018 ◽  
Vol 104 (15) ◽  
pp. 1284-1291 ◽  
Author(s):  
Anton Gard ◽  
Bertil Lindahl ◽  
Gorav Batra ◽  
Nermin Hadziosmanovic ◽  
Marcus Hjort ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Interobserver Agreement ◽  
Plaque Rupture ◽  
Protein Levels ◽  
The Third ◽  
Universal Definition ◽  
Definition Of

ObjectiveThe universal definition of myocardial infarction (MI) differentiates MI due to oxygen supply/demand mismatch (type 2) from MI due to plaque rupture (type 1) as well as from myocardial injuries of non-ischaemic or multifactorial nature. The purpose of this study was to investigate how often physicians agree in this classification and what factors lead to agreement or disagreement.MethodsA total of 1328 patients diagnosed with MI at eight different Swedish hospitals 2011 were included. All patients were retrospectively reclassified into different MI or myocardial injury subtypes by two independent specially trained physicians, strictly adhering to the third universal definition of MI.ResultsOverall, there was a moderate interobserver agreement with a kappa coefficient (κ) of 0.55 in this classification. There was substantial agreement when distinguishing type 1 MI (κ: 0.61), compared with moderate agreement when distinguishing type 2 MI (κ: 0.54). In multivariate logistic regression analyses, ST elevation MI (P<0.001), performed coronary angiography (P<0.001) and larger changes in troponin levels (P=0.023) independently made the physicians agree significantly more often, while they disagreed more often with symptoms of dyspnoea (P<0.001), higher systolic blood pressure (P=0.001) and higher C reactive protein levels on admission (P=0.016).ConclusionDistinguishing MI types is challenging also for trained adjudicators. Although strictly adhering to the third universal definition of MI, differentiation between type 1 MI, type 2 MI and myocardial injury only gave a moderate rate of interobserver agreement. More precise and clinically applicable criteria for the current classification, particularly for type 2 MI diagnosis, are urgently needed.

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