‘Ten Commandments’ for the Fourth Universal Definition of Myocardial Infarction 2018

Universal Definition of Myocardial Infarction 2018The Fourth Universal Definition of Myocardial Infarction (UDMI) Consensus Document was developed jointly by the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation. 1 The mainstay of the Fourth UDMI is based on the ESC/ACC 2000 document on the redefinition of myocardial infarction (MI). 2 The core principle of the redefinition was that myocardial injury detected by abnormal cardiac biomarkers [preferably cardiac troponin (cTn)] in the setting of acute myocardial ischaemia should be labelled as MI.Two revisions followed, the second UDMI in 2007, 3 which introduced a novel MI classification with five subcategories and the third UDMI in 2012, 4 which included amends related to patients undergoing coronary interventions.A fourth update of the UDMI document became necessary for multiple reasons including the ascendency of high sensitivity cTn assays.These assays have substantially changed the way in which the evaluation of MI proceeds although the clinical criteria for MI have not been changed.However, the increased sensitivity of cTn assays have unmasked the fact that there are a large number of circumstances where myocardial injury can exist as an entity in itself in the absence of acute ischaemic heart disease.Essence of this concept and other principal points of the Fourth UDMI include: