The Evolving Process of Myocardial Infarction Classification
https://jamanetwork.com/journals/jamacardiology/fullarticle/2853496
Acute myocardial infarction (MI) has a clear pathological definition: the death of myocardial cells caused by prolonged ischemia. However, in a clinical setting, it is considerably more difficult to establish the diagnosis of MI. In 2007, a consortium of the European Society of Cardiology, the American College of Cardiology Foundation, the American Heart Association, and the World Heart Federation proposed the Universal Definition of Myocardial Infarction (UDMI) to guide diagnosis and classification of MI. Advances in understanding the pathophysiological mechanisms of myocardial injury, advances in diagnostic techniques as well as signals from daily practice regarding performance, and problems of the UDMI led to 3 subsequent iterations of the consensus document. The most recent version, the fourth UDMI, was published in 2018. The current UDMI-based clinical definition of MI requires a combination of a rise and fall in high-sensitivity cardiac troponin, with at least 1 value above the 99th percentile upper reference limit, and evidence of acute myocardial ischemia that includes 1 or more of the following: presence of symptoms, new ischemic changes on electrocardiography, development of pathological Q waves, imaging evidence of new loss of viable myocardium, a new regional wall-motion abnormality, or identification of a coronary thrombus. Although the fourth UDMI provided better pathophysiology-oriented MI diagnoses and classifications than prior versions, the increased complexity of the classification inevitably negatively impacts operational utility and ease of use in daily practice.
August 29, 2026 563 3
