Routine cardiac troponin assessment after percutaneous coronary intervention: useful or hype?

: Although the angiographic and procedural success of percutaneous coronary intervention (PCI) is now very high, some severe complications may still develop, including periprocedural myocardial infarction (MI). An accurate diagnosis of this condition is essential for guiding the clinical management, as these patients may need a tailored management. The current recommendations for diagnosing periprocedural myocardial infarction based on the fourth universal definition appear at first sight straightforward, but the clinical and prognostic significance of routine periprocedural cardiac troponin (cTn) assessment remains uncertain. The current scientific evidence suggests that the likelihood of observing increased periprocedural values of cTn is high, comprising between 30 and 90%. Moreover, cTn values after PCI do not straightforwardly predict major adverse cardiovascular events or all-cause mortality. Although it seems still premature to classify many cases as 'false positive' periprocedural MIs, it is now clear that an isolate 'biochemical diagnosis' of myocardial injury during or immediately after PCI does not translate into early unfavourable clinical consequences. At this point in time, it seems reasonable to suggest that serial cTn assessment should not be routinely performed, but should be reserved for a high-risk subset of PCI patients who have also developed new ECG changes or symptoms suggestive of myocardial ischemia.