Birnbaum, YochaiFiol Sala, MiquelNikus, KjellGarcia Niebla, JavierBacharova, LjubaDubner, SergioZareba, WojciechMacfarlane, Peter WRibeiro, Antonio LuizCygankiewicz, IwonaBayes de Luna, Antoni2024-09-132024-09-132020-09Birnbaum Y, Fiol M, Nikus K, Garcia Niebla J, Bacharova L, Dubner S, et al. A counterpoint paper: Comments on the electrocardiographic part of the 2018 Fourth Universal Definition of Myocardial Infarction endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology. Ann Noninvasive Electrocardiol. 2020 Sep;25(5):e12786. Epub 2020 Jul 8.1082-720Xhttp://hdl.handle.net/20.500.13003/10110https://hdl.handle.net/20.500.12105/23051The Fourth Universal Definition of Myocardial Infarction (FUDMI) focuses on the distinction between nonischemic myocardial injury and myocardial infarction (MI), along with the role of cardiovascular magnetic resonance, in order to define the etiology of myocardial injury. As a consequence, there is less emphasis on updating the parts of the definition concerning the electrocardiographic (ECG) changes related to MI. Evidence of myocardial ischemia is a prerequisite for the diagnosis of MI, and the ECG is the main available tool for (a) detecting acute ischemia, (b) triage, and (c) risk stratification upon presentation. This review focuses on multiple aspects of ECG interpretation that we firmly believe should be considered for incorporation in any future update to the Universal Definition of MI.enghttp://creativecommons.org/licenses/by/4.0/ElectrocardiographyEpidemiologyClinical trialsNon-invasive techniquesreview articleAttribution 4.0 International32638432255e1278610.1111/anec.127861542-474XAnnals of Noninvasive Electrocardiologyopen access2-s2.0-85087645983545977300001L2005498605