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News
For the first time in eight years, major cardiology societies have agreed on how to define a heart attack. The Fifth Universal Definition of Myocardial Infarction (UDMI) ditches the old numerical system in favor of three intuitive clinical categories: primary, secondary, and procedure-related. The update also introduces sex-specific biomarker thresholds and new ICD-11 codes to improve tracking and research.
For the first time in eight years, the world's leading cardiology societies — the ESC, ACC, AHA, and World Heart Federation — have jointly released the Fifth Universal Definition of Myocardial Infarction (UDMI), unveiled at ESC Congress 2026 in Munich and published simultaneously in the European Heart Journal and other major journals.
The biggest shift? Out go the old numerical MI types (1 through 5), and in come three clinically intuitive categories: primary (spontaneous, due to acute coronary pathology like atherothrombosis or SCAD), secondary (oxygen supply-demand imbalance from another acute illness), and procedure-related (cardiac complication within 30 days of PCI or surgery). The new language is designed to be understandable to both clinicians and patients — and to better reflect the underlying biology driving each event.
The update also introduces sex-specific troponin thresholds to reduce the systematic underdiagnosis of MI in women, redefines MINOCA as "myocardial injury" (not infarction) with nonobstructive arteries to signal it's a working diagnosis, and aligns all MI types with ICD-11 codes for the first time — enabling more accurate public health tracking.
Key Takeaways:
Why it matters: Misclassification of MI subtypes has historically affected nearly half of patients, skewing treatment decisions and public health data. This updated framework aims to close that gap — making heart attack diagnosis more precise, equitable, and actionable for clinicians worldwide.
