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Practice Guidelines for Diagnosis of AMI

ESC/ACC Guidelines: Criteria for Acute Evolving or Recent MI¹

Either one of the following criteria satisfies the diagnosis of an acute, evolving or recent MI:

1. Rise and fall of biochemical markers for myocardial necrosis with at least one of the following:

	•	Ischemic symptoms
	•	Development of pathologic Q waves on ECG
	•	ECG changes indicative of ischemia (ST elevation or depression)
	•	Coronary artery intervention (e.g., angioplasty)

2. Pathologic findings of AMI

"Testing for multiple markers of myocardial necrosis, in a manner that emphasizes temporal patterns, could enhance the prompt recognition of high-risk patients and improve risk stratification across a range of patients with chest pain syndromes. This strategy, used at the point of care, making test results more readily available to treating physicians, could improve the efficiency of chest pain management and treatment and triage decisions"

L.K. Newby, A.B. Storrow, W.B. Gibler, et al. Circulation. 2001.²

Ongoing advances in clinical practice, healthcare delivery systems, epidemiological studies and clinical trials have all suggested the need for a more precise definition of MI.

	•	Sensitive biochemical markers enable the detection of myocardial necrosis too small to be associated with QRS abnormalities.¹
	•	The use of cardiac markers has become the standard to risk-stratify chest pain patients.¹

Based on this, a Joint Committee of the European Society of Cardiology and the American College of Cardiology make specific recommendations on the use of biomarkers for the detection of myocardial infarction and have developed the following criteria for AMI diagnosis:²

"Each of these clinical groups [ESC/ACC/AHA] along with the laboratory community has independently reached the conclusion that cardiac troponin is the best marker for diagnosis, risk stratification and guidance of therapy in ACS."

F.S. Apple and A.H.B. Wu. Clinical Chemistry. 2001.³

View more about the latest practice guidelines: ESC/ACC ACC/AHA NACB
	References