{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:30:11Z","timestamp":1792506611609,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","license":[{"start":{"date-parts":[[2024,11,12]],"date-time":"2024-11-12T00:00:00Z","timestamp":1731369600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2024,11,12]]},"abstract":"<jats:p>Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischemia, various classifications have emerged over time, often with conflicting terminology\u2014eg, \u201cstable coronary artery disease\u201d (CAD), \u201cstable ischemic heart disease,\u201d and \u201cchronic coronary syndromes\u201d (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with \u201cacute coronary syndromes\u201d (ACS), the 2023 American guidelines endorsed the alternative term \u201cchronic coronary disease.\u201d An unintended consequence of these competing classifications is perpetuation of the restrictive terms \u201ccoronary\u201d and \u2018disease\u2019, often connoting only a singular obstructive CAD mechanism. It is now important to advance a more broadly inclusive terminology for both obstructive and non-obstructive causes of angina and myocardial ischemia that fosters conceptual clarity and unifies dyssynchronous nomenclatures across guidelines. We, therefore, propose a new binary classification of \u201cacute myocardial ischemic syndromes\u201d and \u201cnon-acute myocardial ischemic syndromes,\u201d which comprises both obstructive epicardial and non-obstructive pathogenetic mechanisms, including microvascular dysfunction, vasospastic disorders, and non-coronary causes. We herein retain accepted categories of ACS, ST-segment elevation MI, and non-ST-segment elevation MI, as important subsets for which revascularization is of proven clinical benefit, as well as new terms like ischemia and MI with non-obstructive coronary arteries. Overall, such a more encompassing nomenclature better aligns, unifies, and harmonizes different pathophysiologic causes of myocardial ischemia and should result in more refined diagnostic and therapeutic approaches targeted to the multiple pathobiological precipitants of angina pectoris, ischemia, and infarction.<\/jats:p>","DOI":"10.1161\/circulationaha.123.065656","type":"journal-article","created":{"date-parts":[[2024,8,30]],"date-time":"2024-08-30T08:01:07Z","timestamp":1725004867000},"page":"1631-1637","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":34,"title":["Myocardial Ischemic Syndromes: A New Nomenclature to Harmonize Evolving International Clinical Practice Guidelines"],"prefix":"10.1161","volume":"150","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7145-8084","authenticated-orcid":true,"given":"William E.","family":"Boden","sequence":"first","affiliation":[{"name":"VA Boston Healthcare System, Boston University School of Medicine, Boston, MA (W.E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1637-574X","authenticated-orcid":true,"given":"Raffaele","family":"De Caterina","sequence":"additional","affiliation":[{"name":"VA Boston Healthcare System, Boston University School of Medicine, Boston, MA (W.E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8068-0189","authenticated-orcid":true,"given":"Juan Carlos","family":"Kaski","sequence":"additional","affiliation":[{"name":"Molecular and Clinical Sciences Research Institute, St. George\u2019s University of London, UK (J.C.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Bairey Merz","sequence":"additional","affiliation":[{"name":"Barbra Streisand Women\u2019s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA (N.B.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4547-8636","authenticated-orcid":true,"given":"Colin","family":"Berry","sequence":"additional","affiliation":[{"name":"British Heart Foundation, Glasgow Cardiovascular Research Centre, University of Glasgow, UK (C.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Marzilli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Pisa and Pisa University Hospital, Italy (R.D.C., M.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6011-681X","authenticated-orcid":true,"given":"Carl J.","family":"Pepine","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Florida School of Medicine, Gainesville (C.J.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0050-5178","authenticated-orcid":true,"given":"Emanuele","family":"Barbato","sequence":"additional","affiliation":[{"name":"Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy (E.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-6967","authenticated-orcid":true,"given":"Giulio","family":"Stefanini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (G.S.)."},{"name":"Humanitas Research Hospital IRCCS, Milan, Italy (G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Prescott","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Research, Bispebjerg Frederiksberg University Hospital, Copenhagen, Denmark (E.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6896-2941","authenticated-orcid":true,"given":"Philippe Gabriel","family":"Steg","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Cit\u00e9, Assistance Publique-H\u00f4pitaux de Paris, FACT and INSERM U1148, Paris, France (P.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1278-6245","authenticated-orcid":true,"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY (D.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5379-1614","authenticated-orcid":true,"given":"Joseph A.","family":"Hill","sequence":"additional","affiliation":[{"name":"Department of Medicine, UT Southwestern Medical Center, Dallas, TX 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