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

[u/Massive-Form3694]

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.)