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
N1 - Funding Information:
EG, KH, OH, BL, JM, KT have no conflicts of interests in relation to the content of this manuscript; ASJ has or presently consults for most of the major diagnostic companies; NLM reports research grants awarded to the University of Edinburgh from Abbott Diagnostics and Siemens Healthineers, and honoraria from Abbott Diagnostics, Siemens Healthineers, Roche Diagnostics and Singulex. Dr. Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the KTI, the European Union, the University of Basel, the University Hospital Basel, the Stiftung für kardiovaskuläre Forschung Basel; Abbott, Beckman Coulter, Idorsia, Ortho Cinical Diagnostics, Quidel, Roche, Siemens, Singulex, Sphingotec, as well as speaker honoraria/consulting honoraria from Acon, Amgen, Astra Zeneca, Boehringer Ingelheim, BMS, Idorsia, Novartis, Osler, Roche, and Sanofi outside of the submitted work. MM received honoraria for lectures from Roche Diagnostics, AstraZeneca, Bayer Vital, Daiichi-Sankyo, Boehringer Ingelheim and BRAHMS Thermo Fisher Scientific. He serves as a consultant for BRAHMS Thermo Fisher Scientific and Bayer, and has received research funding from Roche Diagnostics. He receives public funding outside the current work from the Germany Ministry of Education and Research, the German Innovation Funds for Health Care Research and the Berlin University Alliance. He is editor in chief of the journal ‘Biomarkers’. LC reports research grants awarded to the Royal Brisbane and Women’s hospital from Abbott Diagnostics, Siemens and Beckman Coulter, and honoraria from Abbott Diagnostics and Siemens Healthineers.
Funding Information:
NLM is supported by the British Heart Foundation through the award of the Butler Senior Clinical Research Fellowship [FS/16/14/32023].
Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022/5/26
Y1 - 2022/5/26
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
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 article
C2 - 35603440
AN - SCOPUS:85131199001
SN - 1354-750X
VL - 27
SP - 407
EP - 417
JO - Biomarkers
JF - Biomarkers
IS - 5
ER -