Prognostic Significance of Peri-procedural Myocardial Infarction in the Era of High Sensitivity Troponin: A Validation of the Joint ACCF/AHA/ESC/WHF Universal Definition of Type 4a Myocardial Infarction with High Sensitivity Troponin T

Abstract

PMI as defined by the current Universal Definition using hsTnT is an independent predictor of adverse clinical outcome at 12 months in patients undergoing PCI. Accordingly, PMI remains a clinically relevant factor in current practice and should be considered a key outcome measure in clinical trials and a potential target for therapy.

The impact of a single episode of remote ischemic preconditioning on myocardial injury after elective percutaneous coronary intervention

“…In a recently published article mild to moderate periprocedural myocardial injury was detected in 49.8% of the patients and severe myocardial injury was detected in 12.2% of the patients [16]. Some authors argue that high-sensitivity troponin measurement after PCI can be over-diagnostic; however, it has also been shown that patients with higher troponin levels have worse prognosis [4, 17]. Although there is controversy about the cut-off values for troponin and creatinine kinase (CK)-MB in the determination of PCI-related myocardial infarction [18], the third Universal Definition of Myocardial Infarction Guideline [19] recommended troponin measurement after PCI and defined myocardial infarction after PCI (type 4a MI) as a 5-fold increase of troponin with clinical or electrocardiographic evidence.…”

“…Although its clinical significance is controversial, it has been shown that even minor troponin elevations might be related to irreversible myocardial necrosis [3, 4]. Myocardial injury after PCI can occur due to side branch occlusion, distal embolization, and ischemia/reperfusion injury [2, 5].…”

Postoperative Cardiac Ischemia Detection by Continuous 12-Lead Electrocardiographic Monitoring in Vascular Surgery Patients: A Prospective, Observational Study

“…To establish the diagnosis of PMI, a rise and/or fall of TnT of at least 1 value above the upper reference limit (14 ng/L) and either ischemic ECG changes or other aforementioned ischemic features were required. [18][19][20] Medical conditions potentially causing elevated TnT concentration (sepsis, acute kidney injury, stroke, and pulmonary embolism) were considered when establishing the diagnosis of PMI.…”

Percutaneous Coronary Interventions and Post-Procedural Enzyme Elevation

“…Additionally, an increase greater than 3 times the 99th percentile URL appeared to predict an even worse prognosis, suggesting a dose-response relationship. Recent publications have shown that high sensitivity troponins perform similarly in this context, with elevations occurring in almost 30% of patients and also representing a worse outcome [10]. Thus, although some controversy exists regarding this issue, it is becoming increasingly evident than troponins should consistently be interpreted as a marker of myocardial necrosis after PCI, and therefore predicts adverse clinical events.…”