Will the Real Myocardial Infarction Please Stand Up?

Defining a disease is a process whereby physicians and clinical scientists are able to place a label on a specific pathologic entity. If this label is used carefully, it will characterize that disease process to facilitate future interactions between the patient and the healthcare system. Labeling a patient with a specific diagnosis has important implications for that person with respect to his or her relationship to the rest of society. For example, when a patient is labeled as having suffered a myocardial infarction, that individual’s ability to hold or perform certain jobs (e.g., airline pilot) is altered. He or she may also become eligible to participate in a variety of clinical experiments aimed at improving either the diagnosis or the treatment of patients with myocardial infarction. Unfortunately, clinicians and clinical investigators often define the same disease differently. Furthermore, different clinicians may use different definitions of myocardial infarction. For example, characteristics used to define myocardial infarction in one city or country may be interpreted differently by physicians in another city or country, thereby rendering comparisons between cities or countries difficult if not impossible. In a similar fashion, the definition of myocardial infarction in one international study may differ from that used in another clinical trial. This makes it very difficult to compare the results of different …