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A new clinical classification of acute myocardial infarction

Nature Medicine volume 29, pages 2200–2205 (2023)Cite this article

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Abstract

The existence of a universal definition of myocardial infarction—which involves classification into multiple subtypes—has promoted the use of standard diagnostic criteria across the world. However, this classification has not been applied consistently in practice and is perceived by some as too complicated. Where there is diagnostic uncertainty, patients have worse outcomes. This uncertainty has also impacted on the validity of the diagnosis of myocardial infarction in clinical trials. To address these issues and to encourage clinicians to recognize that different mechanisms of myocardial infarction have differing treatment implications, we propose an alternative clinical classification for consideration; one that recognizes that myocardial infarction can arise spontaneously, secondary to another condition, or as a complication of a cardiac procedure. This classification is aligned with clinical practice and proposes more objective and specific diagnostic criteria that, if agreed by international consensus, could reduce diagnostic uncertainty in practice and research.

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Fig. 1: Proposal for a clinical classification of acute myocardial infarction.

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Acknowledgements

B.L. was a member of the Task Force for the Universal Definition of Myocardial Infarction. N.L.M. is supported by a Chair Award (CH/F/21/90010), Programme Grant (RG/20/10/34966) and a Research Excellent Award (RE/18/5/34216) from the British Heart Foundation.

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Authors and Affiliations

  1. Department of Medical Sciences, University of Uppsala, Uppsala, Sweden

    Bertil Lindahl

  2. BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK

    Bertil Lindahl & Nicholas L. Mills

  3. Usher Institute, University of Edinburgh, Edinburgh, UK

    Nicholas L. Mills

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  1. Bertil Lindahl
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  2. Nicholas L. Mills
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B.L. and N.L.M. drafted and revised the manuscript critically for important intellectual content, provided approval of the final version to be published and are accountable for the work.

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Correspondence to Nicholas L. Mills.

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Competing interests

B.L. declares no competing interests. N.L.M. reports research grants awarded to the University of Edinburgh from Abbott Diagnostics and Siemens Healthineers, and honoraria from Abbott Diagnostics, Siemens Healthineers, Roche Diagnostics and LumiraDx.

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Nature Medicine thanks Adnan Kastrati and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Karen O’Leary, in collaboration with the Nature Medicine team.

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Lindahl, B., Mills, N.L. A new clinical classification of acute myocardial infarction. Nat Med 29, 2200–2205 (2023). https://doi.org/10.1038/s41591-023-02513-2

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