Fourth Universal Definition of Myocardial Infarction (2018)

Kristian Thygesen; Joseph S. Alpert; Allan S. Jaffe; Bernard Chaitman; Jeroen J. Bax; David A. Morrow; Harvey D. White

doi:10.1161/cir.0000000000000617

October 16, 2018CirculationOpen Access

Fourth Universal Definition of Myocardial Infarction (2018)

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Key Points

To provide an updated universal consensus definition differentiating myocardial infarction from myocardial injury and classifying clinical subtypes of myocardial infarction.
Convened an international task force representing the ESC, ACC, AHA, and WHF to establish evidence-based clinical and analytical standards.
Defined biochemical criteria using cardiac troponin and high-sensitivity cardiac troponin 99th percentile upper reference limit thresholds combined with clinical, electrocardiographic, and imaging evidence.
Categorized ischemic myocardial necrosis across five distinct clinical types, including periprocedural settings.
Distinguishes myocardial injury (troponin elevation above the 99th percentile URL without ischemia) from myocardial infarction (troponin dynamic rise and/or fall with at least one ischemic feature).
Maintains the classification of myocardial infarction into Type 1 (atherothrombotic plaque disruption), Type 2 (oxygen supply-demand mismatch), Type 3 (fatal arrest before biomarker confirmation), Type 4 (a, b, c related to PCI), and Type 5 (related to CABG).
Incorporates cardiovascular magnetic resonance and computed tomographic coronary angiography to assess etiology and guide evaluation of conditions like MINOCA and Takotsubo syndrome.

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Implication

The Fourth Universal Definition of Myocardial Infarction provides updated, globally accepted criteria for diagnosing myocardial injury and the five types of myocardial infarction.

Abstract

12 month embargo; published online: 24 August 2018

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Cite This Study

Thygesen et al. (2018) studied this question.

synapsesocial.com/papers/6967d5afb7f979cc77774352 https://doi.org/10.1161/cir.0000000000000617

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Fourth Universal Definition of Myocardial Infarction (2018)

Key Points

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Fourth Universal Definition of Myocardial Infarction (2018)

Key Points

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