Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: An expert consensus document from the society for cardiovascular angiography and interventions (SCAI) |
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| Authors: | Issam D. Moussa MD Lloyd W. Klein MD Binita Shah MD Roxana Mehran MD Michael J. Mack MD Emmanouil S. Brilakis MD John P. Reilly MD Gilbert Zoghbi MD Elizabeth Holper MD Gregg W. Stone MD |
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| Affiliation: | 1. Mayo Clinic, Jacksonville, Florida;2. Division of Cardiology, Department of Medicine, Rush University, Chicago;3. Division of Cardiology, New York University School of Medicine, New York;4. Mount Sinai Medical Center, New York;5. Baylor HealthCare System, Dallas, Texas;6. VA North Texas Healthcare System and UT Southwestern Medical School, Dallas, Texas;7. Oschner Clinic, New Orleans, Luisiana;8. Stern Cardiovascular Foundation, Memphis, Tennessee;9. Medical City Dallas Hospital, Dallas, Texas;10. Columbia University Medical Center, New York Presbyterian Hospital and The Cardiovascular Research Foundation, New York City, New York |
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| Abstract: | Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)‐related MI (type 4a) and coronary artery bypass grafting (CABG)‐related MI (type 5) which are of uncertain prognostic importance. In addition, for both MI types cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK‐MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than employing an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large‐scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a “clinically relevant MI.” The present document introduces a new definition for "clinically relevant MI" after coronary revascularization (PCI or CABG) which is applicable for use in clinical trials, patient care, and quality outcomes assessment. © 2013 Wiley Periodicals, Inc. |
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| Keywords: | coronary revascularization cardiac biomarkers myocardial infarction definition |
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