The Universal Definition of Myocardial Infarction

cute myocardial infarction (MI) historically is defined as a clinical syndrome that meets a certain set of criteria, usually a combination of symptoms, electrocardiographic changes, and cardiac biomarkers in the proper clinical context. These criteria have evolved and have been interdigitated with noninvasive and invasive diagnostic imaging and biomarkers. Before 2000, clinicians used a variety of MI definitions. To provide consistency, the Task Force for the Universal Definition of Myocardial Infarction (UDMI) developed international, collaborative, multidisciplinary, consensus definitions to facilitate standardization and a clear nomenclature based on pathophysiology. 1 Although 2 of the authors of the present article were involved in those efforts, our advocacy now reflects our individual concerns with the suggestions made to change the UDMI rather than a feeling that the document cannot be improved. Accordingly, we provide clarification about issues recently raised concerning the UDMI. It is neither a clinical practice guideline nor a clinical decision pathway. Three elements are key. First, it is a pathophysiologic-based scheme. It predicates the diagnosis of acute MI as a clinical syndrome based on common signs and symptoms of acute myocardial ischemia. Finally, recognizing the variability in diagnostic resource availability across the globe, it endorses a definition based on criteria that can be implemented widely.