State-of-the-art diagnosis of myocardial infarction

The current version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. An acute myocardial infarction (AMI) is characterized by evidence of myocardial necrosis in a clinical setting of acute myocardial ischemia. Diagnostic criteria include a rise and/or fall of serially tested cardiac biomarkers (preferentially cardiac troponins) with at least one value above the 99th percentile of the upper reference limit combined with symptoms of ischemia, new changes on electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormalities or the identification of an intracoronary thrombus by angiography or autopsy. Compared to previous versions, the current definition of MI includes minor modifications regarding ECG criteria and subtypes of MI as well as the use of cardiac imaging and high sensitivity troponin assays. This article summarizes the Universal MI definition and includes recommendations from the current guidelines for the management of patients with acute coronary syndrome. Strategies for "early rule-in" and "rule-out" of non-ST-elevation MI with high sensitivity cardiac troponin assays, risk scores for assessment of ischemic and bleeding risk and criteria for optimal timing of angiography are presented.