What are the criteria used to diagnose myocardial infarction (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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According to the third universal definition of MI, implemented by a joint task force from the European Society of Cardiology (ESC), American College of Cardiology (ACC) Foundation, American Heart Association (AHA), and the World Heart Federation (WHF), MI is diagnosed when either of the following two criteria are met. [9]

1. Detection of an increase or decrease in cardiac biomarker values (preferably using cardiac troponin [cTn]) with at least one value above the 99th percentile of the upper reference limit (URL) and with at least one of the following findings:

  • Symptoms of ischemia
  • New or presumed new significant ST-segment-T wave (ST-T) changes or new left bundle branch block (LBBB)
  • Development of pathologic Q waves on the ECG
  • Imaging evidence of new loss of viable myocardium or a new regional wall motion abnormality
  • Identification of an intracoronary thrombus by angiography or autopsy

2. Cardiac death with symptoms suggestive of myocardial ischemia and presumed new ischemic changes or injury or new BBB on ECG, but death occurred before cardiac biomarker levles were obtained, or before cardiac biomarker values would be increased.

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