| Myocardial injury | Presence of elevated cardiac troponin value above the assay-specific 99th percentile upper reference limit (URL) |
| Chronic myocardial injury | Myocardial injury but no acute change in serial measurement |
| Acute myocardial injury | Myocardial injury with rise or fall (> 20%) in serial measurement |
| Acute myocardial infarction |
Acute myocardial injury with clinical evidence of acute myocardial ischemia: - Symptoms of myocardial ischemia (e.g. chest pain) - New ischemic ECG changes - Development of pathological Q waves - Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology; Identification of a coronary thrombus by angiography or autopsy |
| Type 1 myocardial infarction | Myocardial infarction caused by atherothrombotic coronary artery disease and usually precipitated by atherosclerotic plaque disruption (rupture or erosion) |
| Type 2 myocardial infarction |
Myocardial infarction caused by a mismatch between oxygen supply and demand by a pathophysiological mechanism other than coronary atherothrombosis (e.g. tachyarrhythmia, hypotension or shock, severe anemia) |
| Acute non-ischemic myocardial injury | Myocardial injury in the absence of an ischemic cause (i.e. no evidence of myocardial ischemia as described above in myocardial infarction) |
| Takotsubo Syndrome (TTS) | Acute but mostly reversible heart failure syndrome that can mimic myocardial infarction. TTS is often triggered by a preceding emotionally or physically stressful event. The pathophysiologic mechanism is thought to be a strong sympathetic stimulation with overshooting catecholamine levels. Over 90% of patients with TTS are postmenopausal women |
| Stroke-heart syndrome | Evidence of acute myocardial injury, cardiac dysfunction, or cardiac arrhythmia within 30 days after acute ischemic stroke with peak within 72 h and potential long-term cardiac sequelae. Cardiac symptoms are either newly detected after the ischemic stroke event, or clear evidence shows worsening of cardiac function after stroke. Needs to be differentiated from type 1 MI and systemic causes of non-ischemic myocardial injury |