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| Criteria for the Definition of Acute Myocardial Infarction |
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| The term myocardial infarction (MI) should be used when there is evidence of myocardial necrosis in a clinical setting consistent with acute myocardial ischemia. | |
| Detection of a rise or fall of cardiac biomarker values (preferably cardiac troponin) with at least one value above the 99th percentile URL together with at least one of the following: | |
| (i) symptoms of ischemia, | |
| (ii) new significant ST changes or LBBB, | |
| (iii) development of pathological Q-waves, | |
| (iv) imaging evidence, | |
| (v) intracoronary thrombus. | |
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| Type 1: Spontaneous myocardial infarction | |
| MI related to atherosclerotic plaque rupture with resulting intraluminal thrombus in the coronary artery. | |
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| Type 2: Myocardial infarction secondary to an ischemic imbalance | |
| MI where a condition other than CAD contributes to an imbalance between oxygen supply and demand. | |
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| Type 3: Myocardial infarction resulting in death when biomarkers are unavailable | |
| Cardiac death with symptoms of myocardial ischemia and presumed new ECG changes but death occurring before biomarkers results are available or before biomarkers could rise. | |
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| Type 4a: Myocardial infarction related to PCI | |
| MI associated with PCI arbitrarily defined by | |
| (i) an elevation of cTn >5 times the 99th percentile URL in patients with normal cTn baseline values, | |
| (ii) a rise of cTn >20% in patients with elevated baseline cTn values | |
| plus | |
| (i) symptoms suggestive of ischemia, | |
| (ii) new ischemic ECG changes, | |
| (iii) angiographic evidence, or | |
| (iv) imaging evidence. | |
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| Type 4b: Myocardial infarction related to stent thrombosis | |
| MI related to stent thrombosis is detected by coronary angiography or autopsy in the—setting of myocardial ischemia plus | |
| (i) a rise or fall of cardiac biomarkers above the 99th percentile URL. | |
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| Type 5: Myocardial infarction related to CABG: | |
| MI related to CABG is arbitrarily defined by | |
| (i) an elevation of cTn >10 times the 99th percentile URL in patients with normal cTn baseline values | |
| plus | |
| (i) new pathological Q-waves or LBBB, | |
| (ii) angiographic evidence, or | |
| (iii) imaging evidence. | |
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