A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

Yochai Birnbaum; Miguel Fiol; Kjell Nikus; Javier Garcia Niebla; Ljuba Bacharova; Sergio Dubner; Wojciech Zareba; Peter W Macfarlane; Antonio Luiz Ribeiro; Iwona Cygankiewicz; Antoni Bayes de Luna

doi:10.1111/anec.12786

A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

Ann Noninvasive Electrocardiol. 2020 Sep;25(5):e12786. doi: 10.1111/anec.12786. Epub 2020 Jul 8.

Authors

Affiliations

¹ The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.
² Health Research Institute of the Balearic Islands, Hospital Son Espases, Palma, Spain.
³ Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center, University of Tampere, Tampere, Finland.
⁴ Heart Hospital, Tampere University Hospital, Tampere, Finland.
⁵ Servicios Sanitarios del Area de Salud de El Heirro, Valle del Golfo Health Center, Frontera, Spain.
⁶ International Laser Center, Bratislava, Slovak Republic.
⁷ Institute of Pathophysiology, Medical School, Comenius University, Bratislava, Slovak Republic.
⁸ Clinica y Maternidad Suizo Argentina and De Los Arcos Sanatorio, Buenos Aires, Argentina.
⁹ Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA.
¹⁰ Electrocardiology Section, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
¹¹ Internal Medicine Department, School of Medicine, and Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
¹² Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
¹³ Cardiovascular ICCC- Program, Research Institute Hospital de la Santa Creu i Sant Pau, Cardiovascular Research Foundation, Barcelona, Spain.

Abstract

The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG interpretation that we firmly believe should be considered for incorporation in any future update to the Universal Definition of MI.

Keywords: electrocardiography; epidemiology/clinical trials; non-invasive techniques.

Publication types

Review

MeSH terms

Electrocardiography / methods*
Guidelines as Topic*
Humans
Myocardial Infarction / diagnosis*
Societies, Medical