Why the study?
The Fifth Universal Definition of Myocardial Infarction updates classification to better reflect pathophysiology, clinical evaluation, and objective diagnostic criteria across different MI settings.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“People may think of an MI as a heart attack caused by a blocked coronary artery but there are many different causes of MI. The previous universal definition used a numerical system to categorise the different types of MI but this was not always easy to apply in clinical practice, leading to inconsistences in diagnosis and treatment. The ESC, ACC, AHA and WHF have worked together to devise an updated and simplified classification system for MI, which aims to address these limitations.”
This updated consensus document standardizes the clinical classification and objective diagnostic criteria for myocardial infarction to improve clinical care, research consistency, and public health tracking.
The Fifth Universal Definition of Myocardial Infarction (UDMI) updates the classification to better reflect underlying pathophysiology, align with clinical evaluation of patients, and incorporate objective diagnostic criteria. This classification recognizes that myocardial infarction occurs in three clinical settings. First, myocardial infarction can arise spontaneously due to an acute coronary pathology (primary myocardial infarction). While most presentations are due to atherothrombosis, alternative coronary pathologies can be identified using coronary imaging and functional testing. Second, myocardial infarction may result from another acute condition causing oxygen supply–demand imbalance (secondary myocardial infarction). Here, objective criteria are proposed to guide the use of cardiac and invasive or non-invasive coronary imaging, promoting consistent diagnosis and informing treatment. Third, myocardial infarction may occur as a complication of percutaneous or surgical cardiac procedures (procedure-related myocardial infarction). The diagnosis of procedure-related myocardial infarction does not rely on cardiac biomarker thresholds and is comparable for percutaneous and surgical procedures. In each of these three settings, guidance is provided on the interpretation of symptoms and signs of myocardial ischemia, cardiac biomarkers, and imaging. Alignment of the classification of myocardial infarction with International Disease Classification (ICD)-11 codes, its distinction from myocardial injury, and implications for patients, public health, and research are discussed. It is anticipated that adoption of the classification in practice and research will ensure the diagnosis of myocardial infarction is meaningful for patients and clinicians with clear implications for care across healthcare settings.
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Almahmeed et al. (2026) conducted a review in Myocardial infarction. Fifth Universal Definition of Myocardial Infarction was evaluated. The Fifth Universal Definition of Myocardial Infarction updates the classification of MI into primary, secondary, and procedure-related settings to improve diagnosis and clinical alignment.
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