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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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.
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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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