TY - JOUR
T1 - The clinical approach to diagnosing peri-procedural myocardial infarction after percutaneous coronary interventions according to the fourth universal definition of myocardial infarction–from the study group on biomarkers of the European Society of Cardiology (ESC) Association for Acute CardioVascular Care (ACVC)
AU - Mair, Johannes
AU - Jaffe, Allan
AU - Lindahl, Bertil
AU - Mills, Nicholas
AU - Möckel, Martin
AU - Cullen, Louise
AU - Giannitsis, Evangelos
AU - Hammarsten, Ola
AU - Huber, Kurt
AU - Krychtiuk, Konstantin
AU - Mueller, Christian
AU - Thygesen, Kristian
PY - 2022
Y1 - 2022
N2 - Purpose: This review intends to illustrate basic principles on how to apply the Fourth Universal Definition of Myocardial Infarction (UDMI) for the diagnosis of peri-procedural myocardial infarction (MI) after percutaneous coronary interventions (PCI) in clinical practice. Methods and Results: Review of routine case-based events. Increases in cardiac troponin (cTn) concentrations are common after elective PCI in patients with chronic coronary syndrome (CCS). Peri-procedural PCI-related MI (type 4a MI) in CCS patients should be diagnosed in cases of major peri-procedural acute myocardial injury indicated by an increase in cTn concentrations of >5-times the 99th percentile upper reference limit (URL) together with evidence of new peri-procedural myocardial ischaemia as demonstrated by electrocardiography (ECG), imaging, or flow-limiting peri-procedural complications in coronary angiography. Measurement of cTn baseline concentrations before elective PCI is useful. In patients presenting with acute MI undergoing PCI, peri-procedural increases in cTn concentrations are usually due to their index presentation and not PCI-related, apart from obvious major peri-procedural complications, such as persistent occlusion of a large side branch or no-reflow after stent implantation. Conclusion: The distinction between type 4a MI, PCI-related acute myocardial injury, and chronic myocardial injury can be challenging in individuals undergoing PCI. Careful integration of all available clinical data is essential for correct classification.
AB - Purpose: This review intends to illustrate basic principles on how to apply the Fourth Universal Definition of Myocardial Infarction (UDMI) for the diagnosis of peri-procedural myocardial infarction (MI) after percutaneous coronary interventions (PCI) in clinical practice. Methods and Results: Review of routine case-based events. Increases in cardiac troponin (cTn) concentrations are common after elective PCI in patients with chronic coronary syndrome (CCS). Peri-procedural PCI-related MI (type 4a MI) in CCS patients should be diagnosed in cases of major peri-procedural acute myocardial injury indicated by an increase in cTn concentrations of >5-times the 99th percentile upper reference limit (URL) together with evidence of new peri-procedural myocardial ischaemia as demonstrated by electrocardiography (ECG), imaging, or flow-limiting peri-procedural complications in coronary angiography. Measurement of cTn baseline concentrations before elective PCI is useful. In patients presenting with acute MI undergoing PCI, peri-procedural increases in cTn concentrations are usually due to their index presentation and not PCI-related, apart from obvious major peri-procedural complications, such as persistent occlusion of a large side branch or no-reflow after stent implantation. Conclusion: The distinction between type 4a MI, PCI-related acute myocardial injury, and chronic myocardial injury can be challenging in individuals undergoing PCI. Careful integration of all available clinical data is essential for correct classification.
KW - cardiac troponin
KW - myocardial infarction
KW - myocardial injury
KW - Percutaneous coronary intervention
KW - universal definition of myocardial infarction
KW - Coronary Angiography/adverse effects
KW - Percutaneous Coronary Intervention/adverse effects
KW - Myocardial Infarction/diagnosis
KW - Humans
KW - Biomarkers
KW - Cardiology
UR - http://www.scopus.com/inward/record.url?scp=85131199001&partnerID=8YFLogxK
U2 - 10.1080/1354750X.2022.2055792
DO - 10.1080/1354750X.2022.2055792
M3 - Review
C2 - 35603440
AN - SCOPUS:85131199001
SN - 1354-750X
VL - 27
SP - 407
EP - 417
JO - Biomarkers
JF - Biomarkers
IS - 5
ER -