Fourth universal definition separates MI from myocardial injury

The European Society of Cardiology (ESC), the American College of Cardiology, the American Heart Association, and the World Heart Federation have issued the fourth universal definition of myocardial infarction (MI), which clearly separates MI from myocardial injury, among other updates.

The European Society of Cardiology (ESC), the American College of Cardiology, the American Heart Association, and the World Heart Federation have issued the fourth universal definition of myocardial infarction (MI), which clearly separates MI from myocardial injury, among other updates. The document was published in the European Heart Journal, in Circulation, and on the ESC website and is being presented at the ESC 2018 Congress. "The main thing is an update of the [term] 'myocardial injury,'" said Professor Kristian Thygesen, from Aarhus University Hospital, Denmark, one of three writing committee chairs. "That is because of the increase in use of troponin, especially high-sensitivity troponin," which can detect more minute injury to heart muscle cells. In this definition, "patients with elevated blood troponin levels but without clinical evidence of ischemia are said to have had a 'myocardial injury,'" fellow chair Joseph S. Alpert, MD, from the University of Arizona College of Medicine, Tucson, wrote in an editorial in the American Journal of Medicine. To have a myocardial infarction requires both "an elevated troponin blood test together with clinical evidence of ischemia," such as ischemic patterns in the electrocardiogram, he said.