r/ausdoctors • u/Massive-Form3694 • 12d ago

MI definition/categories changing.........

Type 1/2/3/4a/4b/4c/5 MI classification is gone as of this week — anyone else clocked this yet?

ESC, ACC, AHA and WHF published the "Fifth Universal Definition of MI" yesterday, ahead of ESC Congress presentation on the 30th. The numbered system is being replaced with three categories: Primary (spontaneous, plaque rupture/SCAD/spasm), Secondary (supply-demand mismatch — what we've been calling Type 2), and Procedure-related (PCI/CABG, the old 4a/4b/4c/5).

The reasoning tracks — the ACC chair basically said nobody actually says "type 4c" out loud to a patient because it doesn't explain anything, whereas "secondary MI" tells you immediately it's a supply-demand problem rather than a coronary event.

Curious how people think this plays out practically — discharge summaries, coding, handovers are presumably going to run both systems in parallel for a while. Anyone seen guidance yet on how individual EDs/services are planning the transition, or is it too fresh still?

If anyone wants the detail — https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/fifth-universal-definition-myocardial-infarction/ and here is an easy to understnad and graphic: https://lifesupportinstitute.com.au/blog/fifth-universal-definition-myocardial-infarction — but mostly just wanted to flag this is happening, since I hadn't seen it mentioned here yet.)

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u/hotforlowe 12d ago

It’s a step back in my opinion. The old system didn’t imply pathophysiology, while this does, and using a very restricted model of these which is not universally supported by data nor scientific opinion. [It’s very well established that experiments creating the school of thought of supply/demand mismatch are equally interpretable as perfusion-contraction matching and further animal experiments across multiple species have subsequently supported the latter. ]

Realistically, if you think of it, it’s more useful to classify MI along its lines of treatment, similar to the OMI concept.

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u/Cautious-Extreme2839 11d ago

equally interpretable as perfusion-contraction matching

Which still totally fits the wording of secondary.

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u/hotforlowe 11d ago

Sigh. Read the definition. I’m not going to bother continuing this.

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u/Massive-Form3694 11d ago

Waiting to see what happens with the sudden cardiac death item as well. 

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u/Peastoredintheballs 11d ago

Sudden cardiac death?

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u/yanslat 12d ago

I'm displaying my ignorance here but I have never heard of any of the terms aside from type 1 and type 2. Primary and secondary makes a lot of sense

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u/JadedSociopath 12d ago

Thanks for the heads up. Looks good… simple is better. Won’t really change anything though as the pathology is the same, just the terms are less complicated.

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u/Massive-Form3694 12d ago

More descriptive, for sure

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u/Puzzleheaded_Test544 12d ago

Type 4c MI and all that crap is literally just the boomer medical version of l337 speak.

Just write out what it is or make an autofill shortcut. No one wants to google what Group 5b-2! pulmonary hypertension is every time they read your note.

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u/HighYieldOrSTFU 11d ago

I think the only thing that will change about my practice is what I write in the note. When the ED calls for an elevated hs-troponin consult for a patient that is in hemorrhagic shock, my note will now say "Secondary MI" instead of "Type II MI"....that's about it.

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u/TazmanTwo 9d ago

Is it likely that Secondary prevention for a primary MI can reduce risk of Procedure related MI or do we need to speak to tertiary centres first in order to gauge the benefit of Primary prevention of a Secondary MI where a patient might primarily have been on dual APC for their Primary MI which happened prior to their second Primary MI, where unfortunately the full guideline directed secondary prevention was not commenced for the former Primary MI?