The Third Universal Definition for Acute Myocardial Infarction classifies acute myocardial infarction into various types. The authors are from multiple societies from around the world.
Patient selection: definite or suspected acute myocardial infarction
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Category
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Descriptors
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Type
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spontaneous, involving one or more coronary arteries
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atherosclerotic plaque rupture, ulceration, fissuring, erosion or dissection with intraluminal thrombus or distal platelet emboli
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1
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secondary to ischemic imbalance between myocardial oxygen supply and/or demand
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includes cardiac arrhythmias, hypotension, hypertension, anemia, respiratory failure
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2
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biomarkers unavailable
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presumed AMI but not confirmed by biomarkers (sudden death or specimen not collected)
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3
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related to percutaneous coronary intervention (PCI)
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see below
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4a
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related to stent thrombosis
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see below
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4b
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related to coronary artery bypass grafting (CABG)
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see below
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5
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where:
• Coronary endothelial dysfunction, coronary artery spasm and coronary embolism are included with Type 2.
• Normal baseline value for serum troponin is <= 99th percentile of normal reference group.
Type 4a - both of the following:
(1) one of the following:
(1a) serum troponin values >5 times the 99th percentile of the normal reference population in patients with normal baseline values
(1b) a rise of serum troponin values >20% if the baseline values are elevated and are stable or falling.
(2) one or more of the following:
(2a) symptoms suggestive of myocardial ischaemia, or
(2b) new ischemic ECG changes or new LBBB, or
(2c) angiographic loss of patency of a major coronary artery or a side branch or persistent slow- or no-flow or embolization, or
(2d) imaging demonstration of new loss of viable myocardium or new regional wall motion abnormality are required
Type 4b - all of the following:
(1) stent thrombosis is detected by coronary angiography or autopsy
(2) evidence of myocardial ischaemia
(3) rise and/ or fall of cardiac biomarkers values with at least one value above the 99th percentile for the normal reference population
Type 5 - both of the following:
(1) serum troponin increases to more than 10 times the 99th percentile of normal reference range from a normal baseline concentration
(2) one or more of the following:
(2a) new pathological Q waves or new LBBB, or
(2b) angiographic documented new graft or new native coronary artery occlusion, or
(2c) imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
