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.
Highlights
The Fourth Universal Definition of Myocardial Infarction (FUDMI), published simultaneously in 2018 in numerous journals including Circulation, Journal of the American College of Cardiology and European Heart Journal, focuses mainly on the distinction between nonischemic myocardial injury and myocardial infarction (MI) and the role of cardiovascular magnetic resonance in defining the etiology of myocardial injury, with less emphasis on updating the parts related to the electrocardiographic (ECG) changes related to MI (Thygesen et al, 2019)
The International Society of Electrocardiology (ISE) and the International Society for Holter and Noninvasive Electrocardiology (ISHNE) focus on the ECG and have members that are expert in interpreting ECG changes detected during ischemia and infarction
These recommendations are mainly based on a retrospective study by Widimsky et al (2012). These authors analyzed 6,742 patients with acute MI and found that among the 427 patients with right bundle branch block (RBBB) (53% with concomitant ST elevation), thrombolysis in myocardial infarction (TIMI) flow 0 in the infarct-related artery was present in 51.7% and primary percutaneous coronary intervention was performed in 80.1% of the patients
Summary
The Fourth Universal Definition of Myocardial Infarction (FUDMI), published simultaneously in 2018 in numerous journals including Circulation, Journal of the American College of Cardiology and European Heart Journal, focuses mainly on the distinction between nonischemic myocardial injury and myocardial infarction (MI) and the role of cardiovascular magnetic resonance in defining the etiology of myocardial injury, with less emphasis on updating the parts related to the electrocardiographic (ECG) changes related to MI (Thygesen et al, 2019). The International Society of Electrocardiology (ISE) and the International Society for Holter and Noninvasive Electrocardiology (ISHNE) focus on the ECG and have members that are expert in interpreting ECG changes detected during ischemia and infarction. This counterpoint review focuses on several topics related to the ECG that we believe should be considered to be modified and incorporated into future versions of the document
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