صدر أمس التعريف العالمي الخامس لاحتشاء عضلة القلب (٢٠٢٦) — وثيقة توافق مشتركة بين الجمعيات الأوروبية والأمريكية لأمراض القلب، وفيها إعادة تصنيف شاملة لأنواع الجلطة القلبية.
لخّصتُ في هذا المنشور أهم التغييرات لزملائي المختصين
The 5th Universal Definition of MI. Thankfully, no more type 1, 2, 3, 4a, 4b, 5 MI. Simpler and more clinically relevant.
1. Primary MI. Wider than the old type 1. Atherothrombosis, SCAD, embolism, vasospasm. Stent thrombosis, restenosis, or graft failure past 30 days is now primary, not procedural.
2. Secondary MI. Supply-demand mismatch from another illness. Much stricter now. Demand ischemia plus a troponin bump is not enough. You need obstructive CAD or a new wall motion abnormality.
3. Procedure-related MI. Any cardiac procedure, within 30 days instead of 48 hours. However, we need an angiographic evidence or a new RWMA. Both if it happens during the case itself or the procedure was for an acute MI. Troponin supports the diagnosis but doesn’t make it (>5x URL at 6h for PCI, >35x at 24h for surgery).
4. Type 3 MI is gone. If someone dies, classify by the clinical setting or post-mortem findings.
5. Troponin cutoffs are sex-specific. For high sensitivity troponin, the female upper limit is about half the male.
6. MINOCA is now myocardial injury, not infarction. Non-obstructive means under 50% stenosis. It’s a working diagnosis, since most of these patients turn out to have myocarditis or Takotsubo cardiomyopathy.
7. Silent MI has criteria now. Pathological Q waves aren’t enough. Confirm with imaging, ideally CMR with LGE, new RWMA
8. Shouldn’t say typical and atypical pain; rather chest discomfort. Rather, say “chest discomfort.”
9. A whole section on structural. Bottom line, troponin rise after TAVR by itself is no longer an MI. You need the angio finding or new RWMA.
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