The fourth universal definition focuses on identification of myocardial injury–elevated troponin–and the process of determining the mechanism as ischemic (infarction) or non-ischemic.
An acute myocardial infarction (AMI) is defined as acute myocardial injury with:
- Troponin rise and fall, or fall of already elevated troponin value (with one value above the 99th percentile URL) and
- At least one of the following:
- Symptoms of myocardial ischemia;
- ECG – New ischemic changes;
- ECG – Development of pathologic Q waves;
- Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology;
- Identification of a coronary thrombus by angiography or autopsy (not for types 2 or 3 MIs).
| Type 1 MI | A coronary artery event via plaque disruption or dissection |
| Type 2 MI | Not a coronary artery event. Myocardial oxygen demand is not met by oxygen supply. Coronary artery plaque may or may not be present but is unchanged. |
| Demand Ischemia | Cardiac demand ischemia is the same thing as angina, supply-demand mismatch without infarction: Angina + elevated troponin = AMI Demand ischemia + elevated troponin = type 2 AMI |
Acute myocardial injury is defined as ≥ 20% variance in troponin values (to distinguish from stable elevation).
Coding Rules allow qualifying a diagnosis as “likely,” “probable,” “suspected” at the time of discharge (i.e., discharge summary).
