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-eg, "stable coronary artery disease" (CAD), "stable ischemic heart disease," and "chronic coronary syndromes" (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with "acute coronary syndromes" (ACS), the 2023 American guidelines endorsed the alternative term "chronic coronary disease." An unintended consequence of these competing classifications is perpetuation of the restrictive terms "coronary" and 'disease', 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 "acute myocardial ischemic syndromes" and "non-acute myocardial ischemic syndromes," 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.

中文翻译：

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心肌缺血综合征：协调不断发展的国际临床实践指南的新命名法。


自 1960 年代以来，心脏病专家对急性心肌梗死 （MI） 采用了几种二元分类系统，这有助于改善患者管理。相反，对于心肌缺血的慢性稳定表现，随着时间的推移出现了各种分类，通常术语相互冲突，例如“稳定型冠状动脉疾病”（CAD）、“稳定型缺血性心脏病”和“慢性冠脉综合征”（CCS）。虽然 2019 年欧洲指南引入了 CCS 以赋予与“急性冠状动脉综合征”（ACS） 对称性，但 2023 年美国指南认可了“慢性冠状动脉疾病”的替代术语。这些相互竞争的分类的一个意外后果是限制性术语“冠状动脉”和“疾病”的永久存在，通常只意味着单一的阻塞性 CAD 机制。现在重要的是为心绞痛和心肌缺血的阻塞性和非阻塞性原因提出一个更广泛包容的术语，以促进概念的清晰度并统一指南中不同步的命名法。因此，我们提出了“急性心肌缺血综合征”和“非急性心肌缺血综合征”的新二元分类，其中包括梗阻性心外膜和非梗阻性发病机制，包括微血管功能障碍、血管痉挛性疾病和非冠状动脉原因。我们在此保留了公认的 ACS、ST 段抬高 MI 和非 ST 段抬高 MI 类别，作为血运重建已被证明具有临床益处的重要亚群，以及缺血和非阻塞性冠状动脉 MI 等新术语。 总体而言，这样一个更全面的命名法更好地对齐、统一和协调心肌缺血的不同病理生理原因，并应针对心绞痛、缺血和梗死的多种病理生物学诱因提供更精细的诊断和治疗方法。