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Universal MI Definition Update for Cardiovascular Disease

  • New Therapies for Cardiovascular Disease (KW Mahaffey, Section Editor)
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Abstract

The new third universal definition of myocardial infarction (MI) is based on troponin elevation together with ischemic symptoms, ischemic ECG changes, and imaging evidence. MIs are classified into five types as to whether they are spontaneous, secondary to imbalance between coronary artery blood supply and demand, related to sudden death, or related to revascularization procedures. The definition is based on a rise and/or fall in troponin levels occurring in a clinical setting. There have been modifications over previous definitions with adding intracoronary thrombus as a criterion, adding a new type of MI type 4c, and raising the cutpoint for the diagnosis of MI related to percutaneous coronary intervention to five times the 99th percentile upper reference limit and requiring evidence of ischemia or angiographic complications. In clinical practice, trials, and registries, different definitions are used. There is a need for consistency with regard to the definition of MI and the universal definition should be implemented.

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Conflict of Interest

Harvey White has received research grants from Sanofi Aventis; Eli Lilly; Medicines Company; NIH; Pfizer; Roche; Johnson & Johnson; Schering Plough; Merck Sharpe & Dohme; AstraZeneca; GlaxoSmithKline; Daiichi Sankyo Pharma Development and Bristol-Myers Squibb and has served on Advisory boards for Merck Sharpe & Dohme, Roche, AstraZeneca, and Regado Biosciences.

Kristian Thygesen declares that he has no conflict of interest.

Joseph S. Alpert has performed consulting duties for Johnson & Johnson, Bayer, Janssen, Servier, Sanofi Aventis, Daiichi Sankyo Pharma, Amgen, and Boehringer Ingelheim, and has and been a member of various clinical trial data monitoring committees for Johnson & Johnson, Bayer, Janssen, Genzyme, the Arizona Cancer Center, Duke Clinical Research Institute, and the TIMI group. None of these potential conflicts of interest relate in any way to the material written in this document.

Allan Jaffe has consulted for Beckman, Abbott, Alere, Roche, Radiometer, Trinity, ET Healthcare, Ortho Diagnostics, Critical Diagnostics, and Amgen. He has received payment for development of educational presentations including service on speakers' bureaus from theheart.org. He has received travel/accommodations expenses covered or reimbursed from Roche.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92024, Victoria St West, Auckland, 1142, New Zealand

    Harvey White

  2. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

    Kristian Thygesen

  3. Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA

    Joseph S. Alpert

  4. Cardiovascular Division, Department of Medicine, Laboratory Medicine and Pathology, Mayo Clinic and Medical School, Rochester, MN, USA

    Allan Jaffe

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  1. Harvey White
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  2. Kristian Thygesen
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  3. Joseph S. Alpert
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  4. Allan Jaffe
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Correspondence to Harvey White.

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This article is part of the Topical Collection on New Therapies for Cardiovascular Disease

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White, H., Thygesen, K., Alpert, J.S. et al. Universal MI Definition Update for Cardiovascular Disease. Curr Cardiol Rep 16, 492 (2014). https://doi.org/10.1007/s11886-014-0492-5

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