Fourth Universal Definition Separates Myocardial Infarction From Myocardial Injury

[Lawpy]

From Medscape News

Editorial: https://www.amjmed.com/article/S0002-9343(18)30614-4/fulltext

Article: Fourth universal definition of myocardial infarction (2018) | European Heart Journal | Oxford Academic

Patients with elevated blood troponin levels but without clinical evidence of ischemia are said to have had a ‘myocardial injury.’

All patients with an elevated blood troponin level are said to have a form of myocardial injury, but only patients with a myocardial injury AND clinical evidence of ischemia are said to have myocardial infarction.

The document defines the five subtypes of myocardial infarction as:

• Type 1: Due to an atherosclerotic plaque rupture with subsequent coronary arterial thrombosis; patients can have an ST-elevation or a non-ST elevation myocardial infarction and are usually treated with antiplatelet medication and stenting of the culprit lesion in the coronary artery;
  
  
• Type 2: Due to ischemia (oxygen deprivation) without any plaque disruption; for example, a patient may have hypotension (decreased myocardial oxygen supply) or a tachyarrhythmia (increased myocardial oxygen demand);
  
  
• Type 3: Classic (such as typical ST elevation; electrocardiogram) but no troponin blood test result;
  
  
• Type 4: In the setting of a percutaneous coronary intervention in the catheterization laboratory; and
  
  
• Type 5: At the time of coronary bypass surgery

What are your thoughts?

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[Lawpy]

Here’s a useful flowchart

 

[IMreshopeful]

It’s a good distinction as it separates the idea of people who need some sort of intervention from those who don’t. And it emphasizes that this idiotic idea that troponin = MI which many docs have is not always true.

That being said I doubt EM docs (really, any docs) will make that distinction in reality and will continue to admit and call cardiology for troponinemia without considering the differential of things that are noncardiac.