Prospective evaluation of a new clinical classification of myocardial infarction

For the adoption of a classification of myocardial infarction to improve care, it should be aligned with the diagnostic pathway and based on the underlying pathophysiology with objective diagnostic criteria that enable consistent application in practice and research. We propose such an approach and aim to determine whether this new clinical classification can be applied more consistently than the universal definition of myocardial infarction and provides greater insight into patient outcomes. In a prospective, multi-centre, longitudinal cohort study with diagnostic adjudication, we will enroll consecutive patients with possible myocardial infarction undergoing coronary angiography with and without adjuvant intravascular and cardiac imaging. We will evaluate inter-rater agreement between clinicians and determine whether agreement is improved using the new classification and is influenced by the use of adjuvant imaging. We will compare cardiovascular outcomes in patients with myocardial infarction stratified by both classifications. Finally, in those where the diagnosis remains uncertain following coronary angiography, we will determine the frequency and mechanisms of an elevated cardiac troponin due to analytical interference. Our findings will determine whether a new clinical classification of myocardial infarction could be consistently applied in practice and will provide insights into the role of further testing to inform future guidelines.