Diagnosis of acute myocardial infarction by MONICA and FINMONICA diagnostic criteria in comparison with hospital discharge diagnosis.

WHO MONICA Project has suggested diagnostic criteria for acute myocardial infarction (AMI) for monitoring the trends of coronary heart disease (CHD). The aim of our study was to compare the diagnosis of AMI by the MONICA diagnostic criteria and by the modified criteria developed within the FINMONICA study with hospital discharge (clinical) diagnosis. In a series of 1565 suspected acute CHD events treated at Kuopio University Hospital in 1987-1990, a diagnosis of definite AMI was made clinically in 566 events and by the MONICA (and FINMONICA) criteria in 551 events. The comparability between clinical and MONICA (and FINMONICA) classifications was good (kappa 0.81, Ppos 0.88, Pneg 0.93). A diagnosis of definite or possible AMI was made clinically in 734 events, in 1249 events by the MONICA criteria (kappa 0.25, Ppos 0.69, Pneg 0.47) and in 934 events by the FINMONICA criteria (kappa 0.60, Ppos 0.81, Pneg 0.77). Of the 383 events classified as possible AMI by the FINMONICA criteria the clinical diagnosis was "prolonged angina pectoris attack" or "unstable angina" in 39%. The FINMONICA diagnostic criteria for AMI are closer to clinical diagnostic classification and offer a possibility for a more detailed classification of acute CHD events than the original MONICA criteria.