You are on page 1of 3

3/26/2014

Third Universal Definition of Myocardial Infarction: Clinical Classification of Myocardial Infarction


M ultispecialty M edscape Specialty Sites Allergy & Immunology Anesthesiology Business of M edicine Cardiology Critical Care Dermatology Diabetes & Endocrinology Emergency M edicine Family M edicine Gastroenterology General Surgery Hematology-Oncology HIV/AIDS Infectious Diseases Internal M edicine M ultispecialty Nephrology Neurology Ob/Gyn & Women's Health Oncology Ophthalmology Orthopedics Pathology & Lab M edicine Pediatrics Plastic Surgery Psychiatry Public Health Pulmonary M edicine Radiology Rheumatology Transplantation Urology Dental and Oral Health M edical Students Nurses Pharmacists

Search News No instant look-up matches. Search within full reference content by clicking the "SEARCH" button or pressing enter.
Today News Reference Education Log In Register Adverse Drug Events Clinical Trials Dentistry & Oral Health EHR Ethics Health Diversity Healthcare Reform & the ACA M alpractice M ore

Sunshine Act: The Law, Physicians, and Corporate Attorneys

CV Risk and Saturated Fats: The Debate Roils On

Renal Denervation: Where to After SYMPLICITY HTN-3?

Study Begs FDA Rethink of CT Scan Warning on Cardiac Devices

Third Universal Definition of Myocardial Infarction


Kristian Thygesen, Joseph S. Alpert, Allan S. Jaffe, M aarten L. Simoons, Bernard R. Chaitman, Harvey D. White J Am Coll Cardiol. 2012;60(16):1581-1598. Disclosures

Journal of the American College of Cardiology

http://www.medscape.com/viewarticle/772514_5

1/3

3/26/2014

Third Universal Definition of Myocardial Infarction: Clinical Classification of Myocardial Infarction


Print

Abstract and Introduction Pathological Characteristics of Myocardial Ischemia and Infarction Biomarker Detection of Myocardial Injury With Necrosis Clinical Features of Myocardial Ischemia and Infarction Clinical Classification of Myocardial Infarction Electrocardiographic Detection of Myocardial Infarction Prior Myocardial Infarction Silent Myocardial Infarction Conditions That Confound the ECG Diagnosis of Myocardial Infarction Imaging Techniques Diagnostic Criteria for Myocardial Infarction With PCI (MI Type 4) Diagnostic Criteria for Myocardial Infarction With CABG (MI Type 5) Assessment of MI in Patients Undergoing Other Cardiac Procedures Myocardial Infarction Associated With Non-cardiac Procedures Myocardial Infarction in the Intensive Care Unit Recurrent Myocardial Infarction Reinfarction Myocardial Injury or Infarction Associated With Heart Failure Application of MI in Clinical Trials and Quality Assurance Programs Public Policy Implications of the Adjustment of the MI Definition Global Perspectives of the Definition of Myocardial Infarction
References

Clinical Classification of Myocardial Infarction


For the sake of immediate treatment strategies, such as reperfusion therapy, it is usual practice to designate MI in patients with chest discomfort, or other ischemic symptoms that develop ST elevation in two contiguous leads (see ECG section), as an 'ST elevation MI' (STEMI). In contrast, patients without ST elevation at presentation are usually designated as having a 'non-ST elevation MI' (NSTEMI). Many patients with MI develop Q waves (Q wave MI), but others do not (non-Q MI). Patients without elevated biomarker values can be diagnosed as having unstable angina. In addition to these categories, MI is classified into various types, based on pathological, clinical and prognostic differences, along with different treatment strategies (Table 2).

MOST POPULAR ARTICLES


According to PHYSICIANS

Spontaneous Myocardial Infarction (MI Type 1)


This is an event related to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection with resulting intraluminal thrombus in one or more of the coronary arteries, leading to decreased myocardial blood flow or distal platelet emboli with ensuing myocyte necrosis. The patient may have underlying severe CAD but, on occasion (5 to 20%), nonobstructive or no CAD may be found at angiography, particularly in women.[23,24,25]

1. 2.

Are Doctors Being Exploited? Hate Dealing With an EHR? Use a Scribe and Profits Increase ACA Grace Period Rule Could Put Physicians at Financial Risk Death From Swaddling Patient Satisfaction Is Overrated
View More

3.

4. 5.

Myocardial Infarction Secondary to an Ischemic Imbalance (MI Type 2)


In instances of myocardial injury with necrosis, where a condition other than CAD contributes to an imbalance between myocardial oxygen supply and/or demand, the term 'MI type 2' is employed (Figure 2). In critically ill patients, or in patients undergoing major (non-cardiac) surgery, elevated values of cardiac biomarkers may appear, due to the direct toxic effects of endogenous or exogenous high circulating catecholamine levels. Also coronary vasospasm and/or endothelial dysfunction have the potential to cause MI.[2628]
Figure 2. Differentiation between myocardial infarction (MI) types 1 and 2 according to the condition of the coronary arteries.
(Enlarge Image)

Cardiac Death Due to Myocardial Infarction (MI Type 3)


Patients who suffer cardiac death, with symptoms suggestive of myocardial ischemia accompanied by presumed new ischemic ECG changes or new LBBBbut without available biomarker valuesrepresent a challenging diagnostic group. These individuals may die before blood samples for biomarkers can be obtained, or before elevated cardiac biomarkers can be identified. If patients present with clinical features of myocardial ischemia, or with presumed new ischemic ECG changes, they should be classified as having had a fatal MI, even if cardiac biomarker evidence of MI is lacking.

Myocardial Infarction Associated With Revascularization Procedures (MI Types 4 and 5)


Periprocedural myocardial injury or infarction may occur at some stages in the instrumentation of the heart that is required during mechanical revascularization procedures, either by PCI or by coronary artery bypass grafting (CABG). Elevated cTn values may be detected following these procedures, since various insults may occur that can lead to myocardial injury with necrosis.[29-32] It is likely that limitation of such injury is beneficial to the patient: however, a threshold for a worsening prognosis, related to an asymptomatic increase of cardiac biomarker values in the absence of procedural complications, is not well defined.[3335] Subcategories of PCI-related MI are connected to stent thrombosis and restenosis that may happen after the primary procedure.

Previous Page

9 21

Next Page

http://www.medscape.com/viewarticle/772514_5

2/3

3/26/2014

Third Universal Definition of Myocardial Infarction: Clinical Classification of Myocardial Infarction


LATEST IN CARDIOLOGY

Study Describes Rise and Fall of Nuclear Cardiac Imaging Test FDA Approvals for Tweaked High-Risk Devices Need Revamping 'Bendopnea': A New Symptom to Help Spot Sicker HF Patients? What's Going to Be Hot at ACC 2014 New Data on Bisphosphonates-AF Link: Should FDA Revisit?
J Am Coll Cardiol. 2012;60(16):1581-1598. 2012 Elsevier Science, Inc.

2006 American College of Cardiology

About M edscape Privacy Policy Terms of Use WebM D M edicineNet eM edicineHealth RxList WebM D Corporate Help
All material on this website is protected by copyright, Copyright 1994-2014 by WebMD LLC. This website also contains material copyrighted by 3rd parties.

Also on M edscape - Don't miss

Face Transplant Doc: Challenges in Repairing Destroyed Faces

http://www.medscape.com/viewarticle/772514_5

3/3