Mohammed Salman: 9 Key Changes in the Fifth Universal Definition of Myocardial Infarction
Mohammed Salman, Cardiovascular Invasive Specialist, Cath lab Technologist at Government of Kerala, shared a post on LinkedIn:
“The 5th Universal Definition of MI is out. Simpler and more clinically relevant.
Here is summary on the document:
1. Primary MI. Wider than the old type 1.
Atherothrombosis, SCAD, embolism, vasospasm.
Stent thrombosis, restenosis, or graft failure past 30 days is now primary, not procedural.
2. Secondary MI. Supply-demand mismatch from another illness.
Much stricter now.
Demand ischemia plus a troponin bump is not enough.
You need obstructive CAD or a new wall motion abnormality.
3. Procedure-related MI. Any cardiac procedure, within 30 days instead of 48 hours.
However, we need an angiographic evidence or a new RWMA.
Both if it happens during the case itself or the procedure was for an acute MI.
Troponin supports the diagnosis but doesn’t make it (more than 5 times URL at 6h for PCI, more than 35 times at 24h for surgery).
4. Type 3 MI is gone. If someone dies, classify by the clinical setting or post-mortem findings.
5. Troponin cutoffs are sex-specific. For high sensitivity troponin, the female upper limit is about half the male.
6. MINOCA is now myocardial injury, not infarction. Non-obstructive means under 50 percent stenosis.
It’s a working diagnosis, since most of these patients turn out to have myocarditis or Takotsubo cardiomyopathy.
7. Silent MI has criteria now. Pathological Q waves aren’t enough.
Confirm with imaging, ideally CMR with LGE, new RWMA
8. Shouldn’t say typical and atypical pain; rather chest discomfort.
Rather, say ‘chest discomfort.’
9. A whole section on structural. Bottom line, troponin rise after TAVR by itself is no longer an MI.
You need the angio finding or new RWMA.”
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