New global heart attack definition puts women’s heart health in focus
16 Sep 2026
The Fifth Universal Definition of Myocardial Infarction was released in August 2026 by the European Society of Cardiology, American College of Cardiology, American Heart Association and World Heart Federation.
The updated definition replaces the previous five-number classification with three clinical categories: primary myocardial infarction, secondary myocardial infarction and procedure-related myocardial infarction.
The new approach aims to classify heart attacks according to the underlying cause and the circumstances in which they occur.
Primary myocardial infarction includes acute problems affecting the coronary arteries. These can include atherosclerotic plaque rupture, spontaneous coronary artery dissection (SCAD), coronary artery spasm and coronary embolism.
Secondary myocardial infarction occurs when another condition causes an imbalance between the heart’s oxygen supply and demand.
Procedure-related myocardial infarction refers to heart attacks linked to complications from cardiac procedures, including coronary stenting or heart surgery.
The updated definition also includes sex-specific cardiac troponin thresholds. The task force says this is important because women generally have lower cardiac troponin reference levels than men, and using sex-specific thresholds may help reduce under-recognition of myocardial injury in women.
Associate Professor Sarah Zaman, who chaired the World Heart Federation taskforce, said the revised definition recognises a wider range of causes of myocardial infarction.
SCAD, coronary artery spasm and coronary embolism can be particularly relevant when assessing women with myocardial infarction, including younger women and those experiencing a heart attack during or after pregnancy.
The new definition also encourages the use of imaging and other investigations to help identify the underlying cause of myocardial infarction.
For GPs, understanding the cause behind a myocardial infarction remains important because treatment can differ depending on the underlying condition.
The updated definition also proposes new ICD-11 codes for different types and causes of myocardial infarction. The groups involved say this could support future research, health monitoring and comparison of care.
The Heart Foundation has also supported the use of sex-specific troponin thresholds as part of efforts to improve recognition of heart disease in women.
New global heart attack definition puts women’s heart health in focus
Source: European Society of Cardiology, World Heart Federation and Fifth Universal Definition of Myocardial Infarction, 2026.