Biomarker als Schlüssel zur neuen Definition des Myokardinfarkts

Biomarkers: the key for the new definition of myocardial infarction In the new joint guidelines of international scientific societies for the definition of myocardial infarction cardiac biomarkers, especially the cardiac troponins T and I play a central role as a diagnostic criterion in NONSTEMI. These markers are suitable for risk stratification and provide prognostic information. As new cut-off point the 99th percentile of a healthy reference population was chosen. Moreover an analytical imprecision of less than 10% coefficient of variation at the cut-off point is required by the guidelines. The diagnosis of myocardial infarction includes an appropriate clinical diagnosis and the kinetic of the troponin increase, because increased troponin levels as a sign of myocardial damage may also occur in patients without coronary heart disease. The new definition will lead to an apparent increase in myocardial infarction (according to the AMIS registry in Switzerland by about 6%). It will also have consequences for the patients (psychological, insurance, at the working place, for certain activities, etc). Data from high risk patients with acute coronary syndrome indicate that every measurable troponin value (even below the 99th percentile) is associated with an increased risk. This justifies apart from the standardisation the lowering of the cut-off to the 99th percentile.