Myocardial Infarction: Expert Consensus Group Provides Updated Definition
Am Fam Physician. 2019 Mar 1;99(5):334-335.
Author disclosure: No relevant financial affiliations.
Key Points for Practice
• The term myocardial injury should be used to describe at least one increased cardiac troponin level greater than the 99th percentile upper reference limit.
• The term acute MI should be used to describe an acute myocardial injury (fluctuation in cardiac troponin levels, at least one of which should be greater than the 99th percentile) in the presence of suspected acute myocardial ischemia (based on symptoms, ECG, or imaging).
• Type 1 MI is a result of atherosclerotic plaque rupture and thrombosis, whereas type 2 MI is caused by ischemia from an imbalance of oxygen supply and myocardial demand.
From the AFP Editors
An expert consensus group of the European Society of Cardiology, American College of Cardiology Foundation, American Heart Association, and World Heart Federation has provided an updated universal definition of myocardial infarction (MI). The goals of this new definition were to introduce new concepts, such as distinguishing MI from myocardial injury, as well as to update other concepts, such as emphasizing the use of high-sensitivity cardiac troponin measurement. Confirming an MI diagnosis using this definition will entail an evaluation of clinical factors, electrocardiography (ECG) and other imaging, and laboratory findings, as well as findings from pathology testing as needed, over the timeframe of the event.
The term myocardial injury should be used to describe at least one increased cardiac troponin level greater than the 99th percentile upper reference limit, which can be further defined as acute if the values continue to fluctuate. The term acute MI (types 1, 2, and 3) should be used to describe an acute myocardial injury in the presence of suspected acute myocardial ischemia; fluctuation in cardiac troponin levels, at least one of which should be greater than the 99th percentile; and at least one of the following: myocardial ischemia symptoms, new ischemic changes or pathologic Q waves identified on ECG, imaging
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
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