Heart attacks now sort as primary, secondary or procedure-related
The fifth universal definition sorts every heart attack into primary, secondary and procedure-related. Primary covers artery events, secondary an oxygen supply-and-demand imbalance, and the third group infarction within 30 days of a procedure. The document changes classification and ICD-11 coding. EVAOLD tested stress imaging as gatekeeper to angiography after a non-ST-elevation heart attack in patients aged 80 and over; death, myocardial infarction or stroke at one year ran at 24.1 per cent with imaging and 20.7 per cent with routine invasive care.
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Primary, secondary and procedure-related categories replace the numbered types
The fifth universal definition of myocardial infarction, released at ESC Congress 2026 in Munich, sorts every heart attack into primary, secondary and procedure-related. Primary covers events in the artery itself, such as plaque rupture, spontaneous dissection, spasm or clotting. Secondary covers an oxygen supply-and-demand imbalance driven by another illness. The third group covers infarction within 30 days of cardiac surgery or a cardiac procedure. ESC, ACC, AHA and WHF replace the numbered heart attack types with these three plain categories.[1]
The new names change classification and ICD-11 coding
Nicholas Mills, who chaired for the ESC, said the old numbered scheme was not always easy to apply in practice and left diagnosis and treatment inconsistent. Kristin Newby, who chaired for the ACC and AHA, said the plain categories let a clinician explain the cause of an infarction to a patient instead of quoting a number. The document is also aligned with ICD-11 coding. As a consensus standard it changes how events are classified and coded; it leaves the treatment scheme unrewritten.[1]
EVAOLD stopped stress imaging for futility in patients aged 80 and over
EVAOLD tested whether stress imaging could work as a gatekeeper, sending only older patients with moderate to severe ischaemia after a non-ST-elevation heart attack on to angiography, and was stopped for futility at the first prespecified interim analysis. It stopped early. Death, non-fatal myocardial infarction or non-fatal stroke at one year occurred in 24.1 per cent of the imaging-guided arm and 20.7 per cent of the routine invasive arm. The trial ran at 25 French centres among hospitalised patients aged 80 or over. Gilles Barone-Rochette said the selective strategy reduced the need for coronary angiography and angiography-related complications, but did not show noninferiority to routine invasive management for major cardiovascular events. He said the results should be read in the context of early termination and lower-than-anticipated event rates. The tested selective approach should not replace routine invasive treatment where an invasive strategy is clinically feasible.[2]
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