Primary, secondary or procedure-related: 3 new settings for classifying heart attacks explained

A heart attack, medically known as a myocardial infarction (MI), is a serious health concern worldwide. Traditionally, doctors classified MI based on a numerical system, which could lead to inconsistencies in clinical practice. Recently, four major international cardiac organisations – the European Society of Cardiology, American College of Cardiology, American Heart Association, and World Heart Federation – have introduced a new, simplified method to classify heart attacks.

This new classification categorises MI into three broad clinical settings: primary, secondary, and procedure-related.

Professor Nicholas Mills, chair of the European Society of Cardiology, explains that this new approach shifts focus from the type of MI to the underlying reasons for its occurrence. Primary MI arises spontaneously due to acute problems in a coronary artery, such as plaque rupture, coronary wall tear (SCAD), spasm, or clot formation.

Secondary MI results from an imbalance in oxygen supply and demand caused by conditions like high or low blood pressure or rapid heartbeat. Procedure-related MI occurs within 30 days of a cardiac procedure or surgery.

Dr Parin Sangoi, a consultant interventional cardiologist, highlights that the new definition emphasizes the reasons behind the heart muscle injury, leading to a more accurate classification. This distinction is vital as it allows doctors to tailor their investigation methods based on the specific cause, particularly crucial for women who may experience less-recognised types of coronary disease.

Dr Punya Pratap Kujur, a consultant cardiologist, emphasises the importance of understanding that women may present with heart attacks due to conditions like SCAD, coronary artery spasm, or embolism, which do not always cause the typical severe blockage seen in men. She also stresses that women should not wait for classic symptoms like crushing chest pain but should seek help for new or unexplained symptoms such as breathlessness, fatigue, nausea, sweating, dizziness, or discomfort in the jaw, back, shoulder, or arm.