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Pocket Guidelines on the Fourth Universal Definition of Myocardial Infarction

ESC Pocket Guidelines

Cardiovascular Surgery
Acute Cardiac Care
Interventional Cardiology
Cardiovascular Disease in the Elderly
Acute Coronary Syndromes

Publication Date: 2018

Chairpersons: Kristian Thygesen, Joseph Alpert, Harvey White

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Table of Contents

Abbreviations and acronyms

Universal definitions of myocardial injury and myocardial infarction:


Initiation of the fourth universal definition of myocardial infarction

Pathological characteristics of myocardial ischaemia and infarction

Biomarker detection of myocardial injury and infarction

Clinical presentation and classification of myocardial infarction

Myocardial infarction type 1

Myocardial infarction type 2

Myocardial infarction type 2 and myocardial injury

Myocardial Infarction type 3

Coronary procedure-related myocardial injury

Myocardial infarction associated with PCI (type 4a MI)

Stent/scaffold thrombosis associated with PCI (type 4b MI)

Restenosis associated with PCI (type 4c MI)

Myocardial infarction associated with CABG (type 5 MI)


Recurrent myocardial infarction

Myocardial injury and infarction associated with cardiac procedures
other than revascularization

Myocardial injury and infarction associated with non-cardiac

Myocardial injury or infarction associated with heart failure

Takotsubo syndrome

 Myocardial infarction with non-obstructive coronary arteries (MINOCA)

 Myocardial injury and/or infarction associated with kidney disease

Biochemical approach for diagnosing myocardial injury and infarction

Analytical issues of cardiac troponins

Operationalising criteria for myocardial injury and infarction

Electrocardiographic detection of myocardial infarction

Application of supplemental ECG leads

Prior or silent/unrecognized myocardial infarction

Applying imaging in myocardial infarction


Cardiac magnetic resonance imaging

Regulatory perspective on myocardial infarction in clinical trials