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

Authors

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

Publication Date

7-8-2020

Journal

Annals of Noninvasive Electrocardiology

DOI

10.1111/anec.12786

PMID

32638432

PMCID

PMC7507065

PubMedCentral® Posted Date

7-8-2020

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Electrocardiography, Guidelines as Topic, Humans, Myocardial Infarction, Societies, Medical, electrocardiography, epidemiology/clinical trials, non‐invasive techniques

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.