{"id":2175,"date":"2018-11-14T21:44:32","date_gmt":"2018-11-14T21:44:32","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1383"},"modified":"2026-02-09T19:36:10","modified_gmt":"2026-02-09T19:36:10","slug":"myocardial-infarction","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/myocardial-infarction\/","title":{"rendered":"Universal Definitions of Myocardial Injury and Myocardial Infarction"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>With the introduction of more sensitive cardiac biomarkers, the\u00a0European Society of Cardiology (ESC) and the American College of\u00a0Cardiology (ACC) collaborated to redefine MI using a biochemical\u00a0and clinical approach, and reported that myocardial injury detected\u00a0by abnormal biomarkers in the setting of acute myocardial ischaemia should be labelled as MI.<!--more--><\/p>\n<p><strong>Universal definitions of myocardial injury and myocardial infarction<\/strong><\/p>\n<p><strong>Criteria for myocardial injury<\/strong><br \/>\nThe term myocardial injury should be used when there is evidence of elevated cardiac troponin values (cTn) with at least one value above\u00a0the 99th percentile upper reference limit (URL). The myocardial injury is considered acute if there is a rise and\/or fall of cTn values.<\/p>\n<p><strong>Criteria for acute myocardial infarction (types 1, 2 and 3 MI)<\/strong><br \/>\nThe term acute myocardial infarction should be used when there is acute myocardial injury with clinical evidence of acute myocardial\u00a0ischaemia and with detection of a rise and\/or fall of cTn values with at least one value above the 99th percentile URL and at least one of\u00a0the following:<\/p>\n<ul>\n<li>Symptoms of myocardial ischaemia;<\/li>\n<li>New ischaemic ECG changes;<\/li>\n<li>Development of pathological Q waves;<\/li>\n<li>Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischaemic aetiology;<\/li>\n<li>Identification of a coronary thrombus by angiography or autopsy (not for types 2 or 3 MIs).<\/li>\n<\/ul>\n<p>Post-mortem demonstration of acute athero-thrombosis in the artery supplying the infarcted myocardium meets criteria for type 1 MI.<br \/>\nEvidence of an imbalance between myocardial oxygen supply and demand unrelated to acute athero-thrombosis meets criteria for type 2 MI.<br \/>\nCardiac death in patients with symptoms suggestive of myocardial ischaemia and presumed new ischaemic ECG changes before cTn\u00a0values become available or abnormal meets criteria for type 3 MI.<\/p>\n<p><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script><br \/>\n<ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-0127150553352455\" data-ad-slot=\"7834404329\"><\/ins><br \/>\n<script>\n     (adsbygoogle = window.adsbygoogle || []).push({});\n<\/script><\/p>\n<p><strong>Criteria for coronary procedure-related myocardial infarction (types 4 and 5 MI)<\/strong><br \/>\nPercutaneous coronary intervention (PCI) related MI is termed type 4a MI.<br \/>\nCoronary artery bypass grafting (CABG) related MI is termed type 5 MI.<br \/>\nCoronary procedure-related MI \u2264 48 hours after the index procedure is arbitrarily defined by an elevation of cTn values &gt; 5 times for\u00a0type 4a MI and &gt; 10 times for type 5 MI of the 99th percentile URL in patients with normal baseline values. Patients with elevated\u00a0pre-procedural cTn values, in whom the pre-procedural cTn level are stable (\u2264 20% variation) or falling, must meet the criteria for\u00a0a &gt; 5 or &gt; 10 fold increase and manifest a change from the baseline value of &gt; 20%. In addition with at least one of the following:<\/p>\n<ul>\n<li>New ischaemic ECG changes (this criterion is related to type 4a MI only);<\/li>\n<li>Development of new pathological Q waves;<\/li>\n<li>Imaging evidence of loss of viable myocardium that is presumed to be new and in a pattern consistent with an ischaemic aetiology;<\/li>\n<li>Angiographic findings consistent with a procedural flow-limiting complication such as coronary dissection, occlusion of a major epicardial artery or graft, side-branch occlusion-thrombus, disruption of collateral flow or distal embolization.<\/li>\n<\/ul>\n<p>Isolated development of new pathological Q waves meets the type 4a MI or type 5 MI criteria with either revascularization procedure if\u00a0cTn values are elevated and rising but less than the pre-specified thresholds for PCI and CABG.<br \/>\nOther types of 4 MI include type 4b MI stent thrombosis and type 4c MI restenosis that both meet type 1 MI criteria.<br \/>\nPost-mortem demonstration of a procedure-related thrombus meets the type 4a MI criteria or type 4b MI criteria if associated with a stent.<\/p>\n<p><strong>Criteria for prior or silent\/unrecognized myocardial infarction<\/strong><br \/>\nAny one of the following criteria meets the diagnosis for prior or silent\/unrecognized MI:<\/p>\n<ul>\n<li>Abnormal Q waves with or without symptoms in the absence of non-ischaemic causes.<\/li>\n<li>Imaging evidence of loss of viable myocardium in a pattern consistent with ischaemic aetiology.<\/li>\n<li>Patho-anatomical findings of a prior MI.<\/li>\n<\/ul>\n<p><script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script><br \/>\n<ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-0127150553352455\" data-ad-slot=\"7834404329\"><\/ins><br \/>\n<script>\n     (adsbygoogle = window.adsbygoogle || []).push({});\n<\/script><br \/>\n<strong>References:<\/strong><\/p>\n<ol>\n<li>Mueller C, White HD, Lopez-Ayala P, de Silva R, Kaski JC. Great debate: the universal definition of myocardial infarction is flawed and should be put to rest. Eur Heart J. 2026 Jan 24;47(4):438-452. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40923895\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)\/American College of Cardiology (ACC)\/American Heart Association (AHA)\/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018).\u00a0Glob Heart. 2018 Aug 23. pii: S2211-8160(18)30138-8. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30154043\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)\/American College of Cardiology (ACC)\/American Heart Association (AHA)\/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018).\u00a0J Am Coll Cardiol. 2018 Oct 30;72(18):2231-2264.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30153967\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Nov 13, 2018<br \/>\nUp-date Feb 9, 2026<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[26],"tags":[353,352,351,350,349,348,149,354,344,347,346,345,343],"class_list":["post-2175","post","type-post","status-publish","format-standard","hentry","category-cardiology","tag-definiciones","tag-definitions","tag-iam","tag-infarction","tag-infarto","tag-injuria","tag-injury","tag-mi","tag-miocardica","tag-miocardio","tag-myocardial","tag-universal","tag-universales"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2175","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2175"}],"version-history":[{"count":3,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2175\/revisions"}],"predecessor-version":[{"id":10645,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2175\/revisions\/10645"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2175"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2175"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2175"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}