An updated definition of heart attacks was proposed at the European Society of Cardiology (ESC) congress in Munich in August, which should lead to better care for underdiagnosed conditions including SCAD.
The Fifth Universal Definition of Myocardial Infarction (2026), a consensus statement, produced by the European Society of Cardiology, the American College of Cardiology, the American Heart Association, and the World Heart Federation, proposes changes to the previous system that classified heart attacks into types 1-5, to three categories that ‘better reflect underlying pathophysiology, align with clinical evaluation of patients, and incorporate objective diagnostic criteria’.
While recognising that most heart attacks are caused by atherosclerosis (plaque build-up), there are other causes, including SCAD, which predominantly affects woman, as well as coronary embolism, vasospasm, restenosis, stent thrombosis, or graft failure, and these are now included in the Primary Myocardial Infarction category. This means the emphasis will be on what has caused the heart attack and doing coronary imaging to help diagnose non-atherosclerotic heart attacks, which should help improve diagnosis of SCAD.
The new definition also recommends using sex-specific troponin levels. Troponin is a protein released into the bloodstream when heart muscle is injured, and testing this over time can help diagnose a heart attack. However, the levels used are based on research done on men, and women tend to have lower troponin levels than men, so this can result in women with heart attack symptoms being misdiagnosed or a diagnosis is delayed.
Explaining what the new definition means for patients, ACC/AHA Chair, Professor Kristin Newby from Duke University Medical Center, Durham, USA, said, ‘Clinicians often do not use the previous numerical terminology – e.g. type 2 or type 4c – in patient discussions as it is rather complex. With the new approach, we can now talk with patients about the cause of their MI so that they can understand their condition and recognise why the next steps, such as further tests and treatments, are needed.”
Read the ESC’s press release here.
