Key Summary
- The definition of heart attack has been updated to include symptoms common to women.
- It is agreed by four leading cardiovascular health organisations.
- The guidelines also address bias in biomarker interpretation.
The world’s four leading cardiovascular health organisations have agreed on the first universal definition of a heart attack, to include cardiac events that predominantly affect women.
Announced during the annual congress of the European Society of Cardiology (ESC) in Munich and published in the European Heart Journal, the new clinical guidance was established jointly by the ESC, the American College of Cardiology (ACC), the American Heart Association (AHA), and the World Heart Federation (WHF).
Historically, diagnostic criteria and clinical coding systems have prioritised traditional atherothrombotic events more common in men.
Less common presentations, which evidence shows disproportionately affect women, were frequently classified as lower priority, resulting in suboptimal care, missed diagnoses, or inappropriate interventions.
The new consensus formally upgrades the clinical focus on three distinct types of heart attack that are up to 10 times more common in women:
- Spontaneous Coronary Artery Dissection: A tear in the coronary artery wall, with women accounting for roughly 80% of all cases, often occurring during or shortly after pregnancy.
- Coronary Artery Spasm: Sudden constriction of the artery restricting blood and oxygen supply, frequently triggered by emotional stress, strenuous exercise, or extreme cold.
- Coronary Embolism: Obstruction caused by a blood clot or fatty deposit traveling from elsewhere in the body to a coronary artery.
The guidelines also address bias in biomarker interpretation.
Previously, diagnostic thresholds for cardiac troponin, the key blood protein released during myocardial injury, relied on average population baselines that identified nearly all male presentations while missing lower, sex-specific elevations in women.
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation (BHF), described the overhaul as a watershed moment: "This is a landmark moment, a radical shift in how we define and diagnose heart attacks worldwide which will transform people’s care. For decades, women have missed out on accurate diagnoses and treatment. This focus on finding less common causes of heart attacks, which predominantly affect women, should help to change that. It could be life-changing for huge numbers of women in the UK and worldwide."
Professor Nicholas Mills, a cardiologist at the University of Edinburgh who led the international taskforce, highlighted that aligning global classification is critical for emergency departments: "It kills so many people, and we’ve never got everyone together around the world to agree how we’re going to describe it, classify it, explain it to our patients. It is a revolution. It’s going to make care better for patients."
