颜红兵,霍勇

• 1:深圳新风和睦家医院心脏中心
• 2:国家心血管病中心北京协和医学院中国医学科学院阜外医院
• 3:北京大学第一医院心内科

摘要(Abstract)：

全球心肌梗死定义的统一与标准化，是心血管病精确诊断、标准化治疗、流行病学统计和临床研究同质化的重要基础。自世界卫生组织发布心肌梗死标准化诊断定义第一版以来，全球心肌梗死诊断系统经历了五次主要共识迭代。2026年8月28日，欧洲心脏病学会、美国心脏病学会、美国心脏协会和世界心脏联合会正式发布了全球统一心肌梗死定义的第五版，完成了近二十年来最关键的系统重建。本文系统回顾了自1971年至今心肌梗死统一定义的发展历程，分析各版本修订的背景和核心逻辑，重点解释2026年第五版的突破性更新，比较旧系统与新系统的核心差异，总结新标准在临床诊断与治疗、风险分层、学科研究及公共卫生预防控制方面的价值，并指出现有争议和局限性，为临床应用标准化和科研标准化提供参考。

关键词(KeyWords)： 心肌梗死;统一定义;第五版共识;心肌损伤;缺血证据;诊疗规范;迭代更新

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 颜红兵,霍勇

参考文献(References)：

• [1]Mills NL,Newby LK,Zaman S,et al.Fifth universal definition of myocardial infarction(2026)[J].J Am Coll Cardiol,2026,88(11):1314-1368.DOI:10.1016/j.j acc.2026.07.025.
• [2] Herrick JB.Certain clinical features of sudden obstruction of the coronary arteries[J].JAMA,1912,5 9(24):2015-2020.DOI:10.1001/jama.1912.04270120001001.
• [3]Smith FM.The ligation of coronary arteries with electrocardiographic study[J].Arch Intern Med(Chic),1918,22(1):8-27.DOI:10.1001/archinte.1918.00090120013002.
• [4] Pardee HEB.An electrocardiographic sign of coronary artery obstruction[J].Arch Intern Med(Chic),1920,26(2):244-257.DOI:10.1001/archinte.1920.00100020113007.
• [5]Ladue JS,Wroblewski F,Karmen A.Serum glutamic oxaloacetic transaminase activity in human acute myocardial infarction[J].Science,1954,120(3117):497-4 99.DOI:10.1126/science.120.3117.497.
• [6]White LP.Serum lactic dehydrogenase in myocardial infarction[J].N Engl J Med,1956,255(21):984-988.DOI:10.1056/NEJM195611222552103.
• [7]World Health Organization.Myocardial infarction:standardized diagno stic criteria[R].Geneva:World Health Organization,1971.
• [8]Nomenclature and criteria for diagnosis of ischemic heart disease.Report of the Joint International Society and Federation of Cardiology/World Health Organization task force on standardization of clinical nomenclature[J].Circulation,1979,59(3):607-609.DOI:10.1161/01.cir.59.3.607.
• [9]Alpert JS,Thygesen K,Antman E,et al.Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction[J].J Am Coll Cardiol,2000,36(3):959-969.DOI:10.1016/s0735-1097(00)00804-4.
• [10]Thygesen K,Alpert JS,White HD,et al.Universal definition of myocardial infarction[J].Circulation,2007,116(22):2634-2653.DOI:10.116 1/CIRCULATIONAHA.107.187397.
• [11]Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction[J].J Am Coll Cardiol,2012,60(16):1581-15 98.DOI:10.1016/j.j acc.2012.08.001.
• [12]Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction(2018)[J].Circulation,2018,138(20):e618-e651.DOI:10.1161/CIR.0000000000000617.
• [13]DeFilippis AP,Blaha MJ.Defining myocardial infarction:grades of severity or different aetiology[J].Eur Heart J Acute Cardiovasc Care,2025,14(3):142-144.DOI:10.1093/ehj acc/zuaf025.
• [14]Gaudino M,Jaffe AS,Milojevic M,et al.Great debate:myocardial infarction after cardiac surgery must be redefined[J].Eur Heart J,2024,45(39):4170-4177.DOI:10.1093/eurheartj/ehae416.
• [15]Shah AS,Griffiths M,Lee KK,et al.High sensitivity cardiac troponin and the under-diagnosis of myocardial infarction in women:prospective cohort study[J].BMJ,2015,350:g7873.DOI:10.1136/bmj.g7873.
• [16]Y-Hassan S.Autonomic neurocardiogenic syndrome is stonewalled by the universal definition of myocardial infarction[J].World J Cardiol,2020,12(6):231-247.DOI:10.4330/wjc.v12.i6.231.
• [17]Nagele P.A simplified proposal to redefine acute myocardial infarction versus acute myocardial injury[J].Circulation,2020,141(18):1431-1433.DOI:10.1161/CIRCULATIONAHA.119.044996.
• [18] Cohen B,Hasdai D.Universal definition of myocardial infarction:what must we know?What is next?[J].Heart,2024,110(20):1199-1200.DOI:10.113 6/heartj nl-2024-3245 93.
• [19]Chapman AR,Bularga A,Hung J,et al.Determining the mechanism of myocardial injury and role of coronary artery disease in type 2 myocardial infarction(DEMAND-MI)[J].JACC,2021,77(18_Suppl_1):66.DOI:10.1016/S073 5-1097(21)01425-X.
• [20]Boeddinghaus J,Bularga A,Taggart C,et al.Implications of a new clinical classification of acute myocardial infarction[J].Eur Heart J Acute Cardiovasc Care,2025,14(3):131-141.DOI:10.1093/ehjacc/zuaf002.