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Editor's Correspondence
January 27, 2003

The New Definition of Myocardial Infarction

Arch Intern Med. 2003;163(2):245. doi:10.1001/archinte.163.2.245

In their article, Meier et al1 did not find any statistically significant differences in mortality between the group of patients diagnosed using the older World Health Organization criteria for acute myocardial infarction that relies on history, creatine kinase enzyme level, and/or electrocardiographic changes and the group diagnosed using the newer European Society of Cardiology and the American College of Cardiology criteria that incorporates troponins. However, they did find statistically significant differences in the treatment of these 2 groups of patients, with the former group receiving more aggressive in-hospital management that included the use of transcatheter interventions, heparin, and glycoprotein IIb-IIIa inhibitors. Another strategy that has emerged as important in the management of acute myocardial infarction, which was missing in the analysis by Meier et al, is the use of statin drugs. Four observational studies25 and 2 randomized trials6,7 have suggested that such a strategy not only improves outcome,27 but starting these drug therapies in the acute setting also increases compliance.2,3 It would therefore be interesting to evaluate the rate of statin use between the 2 groups and to determine how these differences might affect the study outcomes.

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