All of the following regarding the 'Universal definition of Ml' are true except?
Ans. c. Three times increase in troponin levels are required for coronary artery bypass grafting (Ref: Braunwald's 9/e pe p1241; 'Universal Definition of Myocardial Infarction': Expert Consensus Document Circulation 2007 (American Heart Association Journals): 'ECS-ACCF-AHA-WHF Universal Definition of Myocardial Infarction': htfp://circ.ahajournals.org/content/116/22/2634.full.pdf)Myocardial Infarction associated with CABG is defined by an increase in cardiac biomarkers to more than 5 times normal (> 5 times above the 99th percentile).Universal Definition of Myocardial InfarctionMyocardial infarction related to ischemia due to primary coronary event (plaque rupture) or imbalance between oxygen demand and supply (coronary spasm, hypotension, etc.)Myocardial Infarction related Sudden Cardiac Death (Death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood.)Myocardial Infarction associated with PCI (in patients with normal baseline troponin values)Myocardial infarction associated with CABG (in patients with normal baseline troponin values.)Detection of rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit (URL) together with evidence of myocardial ischemia with at least one of the following:* Symptoms of ischemia* ECG changes indicative of new ischemia * Development of pathological G waves in the ECG* Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality.Sudden, unexpected cardiac death, involving cardiac arrest, often with:* Symptoms suggestive of myocardial ischemia, and accompanied by* New ST elevation, or new LBBB, and/or* Evidence of fresh thrombus by coronary angiography and/or at autopsyBy convention, increases of biomarkers greater than 3 x 99th percentile URL have been designated as defining PCI-related myocardial infarction.By convention, increases of biomarkers greater than 5 x 99th percentile URL plus either new pathological Q waves or new LBBB, or angiographically documented new graft or native artery occlusion, or imaging evidence of new loss of viable myocardium have been designated as defining CABG- related myocardial infarction.The term myocardial infarction should he used when there is evidence of myocardial necrosis in a clinical setting consistent with myocardial ischaemia.Under these conditions any one of the following criteria meets the diagnosis for myocardial infarction:Detection of rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit (URL) together with evidence of myocardial ischaemia with at least one of the following:Symptoms of ischaemiaECG changes indicative of new ischaemia Development of pathological Q waves in the ECGImaging evidence of new loss of viable myocardium or new regional wall motion abnormality.Sudden, unexpected cardiac death, involving cardiac arrest, often with symptoms suggestive of myocardial ischaemia, and accompanied by presumably new ST elevation, or new LBBB, and/or evidence of fresh thrombus by coronary angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood.For percutaneous coronary interventions (PCI) in patients with normal baseline troponin values, elevations of cardiac biomarkers above the 99th percentile URL are indicative of peri-procedural myocardial necrosis. By convention, increases of biomarkers greater than 3 x 99th percentile URL have been designated as defining PCI- related myocardial infarction. A subtype related to a documented stent thrombosis is recognized.For Coronary Artery Bypass Grafting (CABG) in patients with normal baseline troponin values, elevations of cardiac biomarkers above the 99th percentile URL are indicative of peri-procedural myocardial necrosis. By convention, increases of biomarkers greater than 5 x 99th percentile URL plus either new pathological Q waves or new LBBB, or angiographically documented new graft or native artery occlusion, or imaging evidence of new loss of viable myocardium have been designated as defining CABG-related myocardial infarction.Pathological findings of an acute myocardial infarctionCriteria for Prior Myocardial InfarctionAny one of the following criteria meets the diagnosis for prior myocardial infarction:Development of new pathological Q waves with or without symptomsImaging evidence of a region of loss of viable myocardium that is thinned and fails to contract, in the absence of a non-ischemic cause.Pathological findings of a healed or healing myocardial infarction.
Sudden unexpected cardiac death with symptoms of ischemia
New regional wall motion abnormality with raised cardiac biomarkers
Three times increase in troponin levels are required for coronary artery bypass grafting
Reinfarction can be diagnosed if increased troponin levels by 5-7% in serial samples
Myocardial Infarction