Moving toward a new definition of acute myocardial infarction for the 21stcentury: Status of the ESC/ACC Consensus Conference

The European Society of Cardiology and American College of Cardiology estab lished their initial Joint Consensus Conference in July 1999 to develop a n ew definition of Acute Myocardial Infarction. This action was deemed necess ary because of the development of new sensitive biochemical markers of myoc ardial necroses: Troponins T and I. There were 5 working groups, including one in Electrocardiography. The Conference adopted a definition that requir ed only a history of "ischemic symptoms" and "a typical rise and fall" of a t least one of the biochemical markers. The ECG Working Group strongly advi sed that a term distinctive from "myocardial infarction" such as "myocardia l necrosette" be adopted as the diagnosis for an acute coronary event durin g which the peak biochemical marker level is below that which occurs when s erial evolutionary ECG changes are observed. A pilot substudy from the GUST O IIa Clinical Trial has identified the low end of the "ECG Change Range" t o be: >2X the upper limit of normal for CK-MB, >11X for Troponin T, and >6X for Troponin I.