Impact of changing diagnostic criteria on incidence, management, and outcome of acute myocardial infarction: retrospective cohort study.

We thank the Busselton Population Medical Research Foundation for access to the Busselton health survey data and the Busselton community for their longstanding cooperation and support for the Busselton health study. assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. 5 Homocysteine Lowering Trialists' Collaboration. Lowering blood homo-cysteine with folic acid based supplements: meta-analysis of randomised trials. A prospective study of folate and vitamin B6 and risk of infarc-tion in US physicians. et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins: the atherosclerosis risk in communities (ARIC) study. Serum folate and chronic disease risk: findings from a cohort of United States adults. Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. Ischemic Heart Disease Risk Factor Study Group. Low dietary folate intake is associated with an excess incidence of acute coronary events. Prediction of coronary heart disease mortality in Busselton, Western Australia: an evaluation of the Framingham, national health epidemiologic follow up study, and WHO ERICA risk scores.ine, diet, and cardio-vascular diseases: a statement for healthcare professionals from the nutrition committee, American Heart Association. Acute myocardial infarction used to be defined by criteria based on symptoms, changes in electrocardio-grams and the concentrations of cardiac enzymes, as recommended by the World Health Organization. 1 Specific markers of myocardial damage, including tro-ponin T, are more sensitive indicators than total creat-ine kinase concentration for ischaemic myocardial necrosis and prognosis. 2 In 2000, the European Society of Cardiology and the American College of Cardiology recommended changing the diagnostic criteria for acute myocardial infarction to include raised troponin T concentrations in addition to changes in electrocardiograms or coronary intervention. 3 Some patients with acute coronary syndrome who had been diagnosed as having unstable angina are now classified as having myocardial infarc-tion. We investigated the impact of using the new criteria on the incidence, management, and outcome of myocardial infarction. Since 1997, all patients admitted with chest pain to Monklands Hospital, Airdrie, had their troponin T concentrations measured. We identified patients admitted between April 1997 and December 2000 with a principal diagnosis of acute myocardial infarction, according to the old criteria, from routine discharge data, the databases of the coronary care unit and laboratory, and case notes. We used the databases to identify patients admitted for …