ESC ACC AHA WHF Issue Fifth Universal MI Definition Shifting to Three Clinical Categories
The 2026 universal definition simplifies MI classification into three clinically aligned categories while embedding ICD-11 coding. This change targets diagnostic consistency and downstream research on less common mechanisms. Implementation and coding uptake remain the principal open variables.
The new framework groups all myocardial infarctions into primary MI from acute coronary artery pathology, secondary MI from supply-demand mismatch, and procedure-related MI within 30 days of intervention. This replaces the Type 1-5 numeric system that clinicians reported as inconsistently applied in practice. Alignment with ICD-11 codes is intended to standardize surveillance and enable larger observational studies of under-recognized subtypes such as spontaneous coronary artery dissection.
ESC: At least 40 percent of European centers will adopt the three-category classification in discharge summaries by August 2028
Sources (2)
- [1]Fifth Universal Definition of Myocardial Infarction(https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines)
- [2]2018 Fourth Universal Definition of Myocardial Infarction(https://www.ahajournals.org/doi/10.1161/CIR.0000000000000617)