September 10, 2012Heart
Peri-procedural myocardial infarction: time for re-evaluation of its definition and use as an endpoint in coronary stent trials
Key result
The evolution of myocardial infarction definitions highlights the shift from epidemiological criteria to biomarker-based diagnoses, emphasizing the need to re-evaluate peri-procedural MI endpoints.
Design
Editorial
Authors
Discussion
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Implication
Highlights the historical evolution of myocardial infarction definitions and argues for the re-evaluation of peri-procedural MI as an endpoint in coronary stent trials.
Key Points
- To re-evaluate the clinical definition of peri-procedural myocardial infarction and assess its validity as an endpoint in coronary stent trials.
- Reviewed historical iterations of myocardial infarction definitions, tracing transitions from early WHO epidemiological criteria to modern universal definitions.
- Analyzed performance characteristics of cardiac biomarkers, comparing creatine kinase-MB to contemporary high-sensitivity cardiac troponin assays.
- Evaluated the distinct procedural mechanisms of myocardial injury during percutaneous coronary intervention, including side-branch occlusion and distal microvascular embolization.
- High-sensitivity cardiac troponin assays detect circulating biomarker concentrations tenfold lower than conventional assays, offering superior sensitivity and prognostic value over creatine kinase-MB.
- Varying procedural mechanisms—such as side-branch compromise, vessel dissection, and the no-reflow phenomenon—produce diverse biomarker elevations, complicating the clinical interpretation of peri-procedural injury.
PICO
P
Population
Peri-procedural myocardial infarction
Highlights the historical evolution of myocardial infarction definitions and argues for the re-evaluation of peri-procedural MI as an endpoint in coronary stent trials.
Cite This Study
O’Sullivan et al. (2012) conducted a review in Peri-procedural myocardial infarction. The evolution of myocardial infarction definitions highlights the shift from epidemiological criteria to biomarker-based diagnoses, emphasizing the need to re-evaluate peri-procedural MI endpoints.