Fourth Universal Definition of Myocardial Infarction
Cardiology
Also known as: Vierte universelle Definition des Myokardinfarkts (Typ 1-5) · Miyokard enfarktüsünün dördüncü evrensel tanımı · Fourth Universal Definition of Myocardial Infarction: MI types 1-5
What it is for
Fourth Universal Definition of Myocardial Infarction (MI): MI means acute myocardial injury (a rise and/or fall of cardiac troponin with at least one value above the 99th percentile upper reference limit (URL)) together with clinical evidence of acute myocardial ischaemia: ischaemic symptoms, new ischaemic ECG changes, new pathological Q waves, or imaging evidence of new loss of viable myocardium or new regional wall-motion abnormality in an ischaemic pattern. Troponin above the URL without ischaemia is myocardial injury, not MI.
Classification
| Category | Description |
|---|---|
| Type 1 | spontaneous MI caused by atherothrombotic coronary artery disease, usually plaque rupture or erosion; identification of a coronary thrombus at angiography or autopsy is an additional supporting criterion. |
| Type 2 | MI caused by an imbalance between myocardial oxygen supply and demand, without acute coronary atherothrombosis. |
| Type 3 | cardiac death suggestive of MI (ischaemic symptoms, presumed new ischaemic ECG changes) occurring before cardiac troponin can be obtained or confirmed. |
| Type 4a | MI related to percutaneous coronary intervention (PCI) within 48 hours: troponin rise to more than 5 times the URL (with normal baseline; with a raised baseline a further rise of more than 20% to above 5 times the URL), plus new evidence of myocardial ischaemia. |
| Type 4b / 4c | 4b: stent or scaffold thrombosis; 4c: restenosis after PCI. |
| Type 5 | MI related to coronary artery bypass grafting (CABG) within 48 hours: troponin rise to more than 10 times the URL (with normal baseline; with a raised baseline a further rise of more than 20%), plus additional clinical evidence of new ischaemia as specified in the definition. |
Source
Fourth universal definition of myocardial infarction (2018)
ESC/ACC/AHA/WHF · Eur Heart J 2019;40:237-269 (Thygesen K et al.)
PMID: 30165617
- Edition
- Fourth Universal Definition of Myocardial Infarction (2018, joint ESC/ACC/AHA/WHF task force)
- Checked on
Summary of the published classification in our own words. Not a substitute for the original publication.
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