A call for universal definition of myocardial infarction after cardiac surgery

Kristian Thygesen; Allan S. Jaffe

doi:10.1093/ejcts/ezae130

A call for universal definition of myocardial infarction after cardiac surgery

^*Corresponding author for this work

Department of Clinical Medicine - The Department of Cardiological Medicine B

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Defining concepts that enable clinicians and patients to communicate effectively concerning myocardial infarction associated with cardiac surgery requires an accurate, clear and easily interpreted definition. If the diagnostic criteria are accurate and reproducible, it will facilitate clinical care and clinical trials. Furthermore, it would allow for results from 1 clinical trial to be compared and even combined with the results of other trials. Unfortunately, the ideal world of a universally understood and applied definition does not exist in the domain of procedure-related myocardial infarction (PMI). Over the years differing definitions using different diagnostic tools have been employed and consequently, it is often a challenge to compare the ‘apples’ in 1 study to the ‘oranges’ in another. Thus, studies involving large databases employing hospital discharge diagnoses often contain significant inaccuracies since the definitions of PMI employed are highly variable. the proposed revision accounts for approximately two-thirds of PMIs whereas non-graft-related causes subsume the rest and are more frequent in patients undergoing combined surgical procedures [5]. The extent of biomarker elevation differs across different cardiac surgical procedures showing the highest levels after more extensive surgery, such as combined valve and CABG surgery and isolated mitral valve surgery, and the lowest levels after isolated aortic valve replacement and isolated CABG [4]. Being so, it’s not surprising that definitions of PMI relying solely on the release of biomarkers release have generated substantial controversy, and there is no general consensus on cut-off values to be used [6]. Thus, as we have begun to appreciate some prognostic signals, usually increased mortality, there has been a call to use these prognostic thresholds as the paper from the EACTS group suggests [4].

Original language	English
Article number	ezae130
Journal	European Journal of Cardio-Thoracic Surgery
Volume	65
Issue	4
ISSN	1010-7940
DOIs	https://doi.org/10.1093/ejcts/ezae130
Publication status	Published - Apr 2024

Keywords

cardiac surgery
cardiac troponin
diagnostic criteria
procedure related myocardial infarction
Heart
Myocardial Infarction/diagnosis
Humans
Cardiac Surgical Procedures/adverse effects
Thoracic Surgery

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abstract = "Defining concepts that enable clinicians and patients to communicate effectively concerning myocardial infarction associated with cardiac surgery requires an accurate, clear and easily interpreted definition. If the diagnostic criteria are accurate and reproducible, it will facilitate clinical care and clinical trials. Furthermore, it would allow for results from 1 clinical trial to be compared and even combined with the results of other trials. Unfortunately, the ideal world of a universally understood and applied definition does not exist in the domain of procedure-related myocardial infarction (PMI). Over the years differing definitions using different diagnostic tools have been employed and consequently, it is often a challenge to compare the {\textquoteleft}apples{\textquoteright} in 1 study to the {\textquoteleft}oranges{\textquoteright} in another. Thus, studies involving large databases employing hospital discharge diagnoses often contain significant inaccuracies since the definitions of PMI employed are highly variable. the proposed revision accounts for approximately two-thirds of PMIs whereas non-graft-related causes subsume the rest and are more frequent in patients undergoing combined surgical procedures [5]. The extent of biomarker elevation differs across different cardiac surgical procedures showing the highest levels after more extensive surgery, such as combined valve and CABG surgery and isolated mitral valve surgery, and the lowest levels after isolated aortic valve replacement and isolated CABG [4]. Being so, it{\textquoteright}s not surprising that definitions of PMI relying solely on the release of biomarkers release have generated substantial controversy, and there is no general consensus on cut-off values to be used [6]. Thus, as we have begun to appreciate some prognostic signals, usually increased mortality, there has been a call to use these prognostic thresholds as the paper from the EACTS group suggests [4].",

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AB - Defining concepts that enable clinicians and patients to communicate effectively concerning myocardial infarction associated with cardiac surgery requires an accurate, clear and easily interpreted definition. If the diagnostic criteria are accurate and reproducible, it will facilitate clinical care and clinical trials. Furthermore, it would allow for results from 1 clinical trial to be compared and even combined with the results of other trials. Unfortunately, the ideal world of a universally understood and applied definition does not exist in the domain of procedure-related myocardial infarction (PMI). Over the years differing definitions using different diagnostic tools have been employed and consequently, it is often a challenge to compare the ‘apples’ in 1 study to the ‘oranges’ in another. Thus, studies involving large databases employing hospital discharge diagnoses often contain significant inaccuracies since the definitions of PMI employed are highly variable. the proposed revision accounts for approximately two-thirds of PMIs whereas non-graft-related causes subsume the rest and are more frequent in patients undergoing combined surgical procedures [5]. The extent of biomarker elevation differs across different cardiac surgical procedures showing the highest levels after more extensive surgery, such as combined valve and CABG surgery and isolated mitral valve surgery, and the lowest levels after isolated aortic valve replacement and isolated CABG [4]. Being so, it’s not surprising that definitions of PMI relying solely on the release of biomarkers release have generated substantial controversy, and there is no general consensus on cut-off values to be used [6]. Thus, as we have begun to appreciate some prognostic signals, usually increased mortality, there has been a call to use these prognostic thresholds as the paper from the EACTS group suggests [4].

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A call for universal definition of myocardial infarction after cardiac surgery

Abstract

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