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[4th universal definition of myocardial infarction 2018 : What is new?]

C Brinkmann1, J Schofer2

  • 1Medizinisches Versorgungszentrum Prof. Dr. Mathey, Prof. Dr. Schofer, Wördemannsweg 25-27, 22527, Hamburg, Deutschland.

Herz
|October 19, 2018
PubMed

Insights

The 4th universal definition of myocardial infarction provides updated guidance on differentiating myocardial injury from infarction, focusing on troponin levels and assay comparisons. It also introduces new chapters on takotsubo syndrome and myocardial infarction with non-obstructive coronary arteries (MINOCA).

Area of Science:

  • Cardiology
  • Biomarkers
  • Clinical Diagnostics

Background:

  • The 2012 consensus document required updates to reflect advancements in diagnosing myocardial infarction.
  • Distinguishing myocardial injury from infarction, particularly periprocedural events, remains a clinical challenge.

Purpose of the Study:

  • To present the 4th universal definition of myocardial infarction, incorporating recent scientific and clinical findings.
  • To clarify diagnostic criteria, biomarker interpretation, and introduce new clinical entities.

Main Methods:

  • Consensus-based review and update of existing definitions and guidelines.
  • Inclusion of new chapters addressing emerging concepts in myocardial infarction.

Main Results:

  • Refined criteria for myocardial infarction, emphasizing troponin elevation and kinetics.
  • Minor revisions to the five types of myocardial infarction.
  • Introduction of high-risk electrocardiogram constellations.
  • New sections on takotsubo syndrome and myocardial infarction with non-obstructive coronary arteries (MINOCA).

Conclusions:

  • The 4th universal definition offers a comprehensive update for diagnosing myocardial infarction.
  • Enhanced focus on cardiac biomarkers, ECG interpretation, and novel clinical presentations like MINOCA and takotsubo syndrome.

Keywords:
Expert consensus documentHigh-sensitive cardiac troponinMINOCAMyocardial infarctionMyocardial injury

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