Hartikainen Tau S, Sörensen Nils Arne, Haller Paul Michael, Goßling Alina, Lehmacher Jonas, Zeller Tanja, Blankenberg Stefan, Westermann Dirk, Neumann Johannes Tobias
Department of Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Eur Heart J. 2020 Jun 14;41(23):2209-2216. doi: 10.1093/eurheartj/ehaa035.
The recently released 4th version of the Universal Definition of Myocardial Infarction (UDMI) introduces an increased emphasis on the entities of acute and chronic myocardial injury. We applied the 4th UDMI retrospectively in patients presenting to the emergency department with symptoms potentially indicating myocardial infarction (MI) to investigate its effect on diagnosis and prognosis.
We included 2302 patients presenting to the emergency department with symptoms suggestive of MI. The final diagnosis was adjudicated sequentially according to the 3rd and 4th UDMI. Reclassification after readjudication was assessed. Established diagnostic algorithms for patients with suspected MI were applied to compare diagnostic accuracy. All patients were followed to assess mortality, recurrent MI, revascularization, and rehospitalization to investigate the effect of the 4th UDMI on prognosis. After readjudication, 697 patients were reclassified. Most of these patients were reclassified as having acute (n = 78) and chronic myocardial injury (n = 585). Four hundred and thirty-four (18.9%) patients were diagnosed with MI, compared with 501 (21.8%) MIs when adjudication was based on the 3rd UDMI. In the non-MI population, patients with myocardial injury (n = 663) were older, more often female and had worse renal function compared with patients without myocardial injury (n = 1205). Application of diagnostic algorithms for patients with suspected MI revealed a high accuracy after readjudication. Reclassified patients had a substantially higher rate of cardiovascular events compared with not-reclassified patients, particularly patients reclassified to the category of myocardial injury.
By accentuating the categories of acute and chronic myocardial injury the 4th UDMI succeeds to identify patients with higher risk for cardiovascular events and poorer outcome and thus seems to improve risk assessment in patients with suspected MI. Application of established diagnostic algorithms remains safe when using the 4th UDMI.
最近发布的第4版心肌梗死通用定义（UDMI）对急性和慢性心肌损伤的实体给予了更多关注。我们对因出现可能提示心肌梗死（MI）症状而到急诊科就诊的患者进行了第4版UDMI的回顾性应用，以研究其对诊断和预后的影响。
我们纳入了2302例因出现提示MI症状而到急诊科就诊的患者。最终诊断根据第3版和第4版UDMI依次判定。评估重新判定后的重新分类情况。应用针对疑似MI患者的既定诊断算法来比较诊断准确性。对所有患者进行随访，以评估死亡率、复发性MI、血运重建和再次住院情况，从而研究第4版UDMI对预后的影响。重新判定后，697例患者被重新分类。这些患者大多数被重新分类为患有急性（n = 78）和慢性心肌损伤（n = 585）。根据第4版UDMI判定时，有434例（18.9%）患者被诊断为MI，而基于第3版UDMI判定时为501例（21.8%）MI。在非MI人群中，与无心肌损伤的患者（n = 1205）相比，有心肌损伤的患者（n = 663）年龄更大，女性更多见，且肾功能更差。对疑似MI患者应用诊断算法显示重新判定后具有较高的准确性。与未重新分类的患者相比，重新分类的患者心血管事件发生率显著更高，尤其是重新分类到心肌损伤类别的患者。
通过强调急性和慢性心肌损伤类别，第4版UDMI成功识别出心血管事件风险更高且预后较差的患者，因此似乎改善了疑似MI患者的风险评估。使用第4版UDMI时，应用既定诊断算法仍然安全。
