A new definition for clinically relevant myocardial infarction after coronary revascularization is proposed, utilizing biomarker thresholds strongly linked to subsequent adverse events.
Should a new definition of clinically relevant MI based on prognostically significant biomarker thresholds replace the universal definition of MI after coronary revascularization?
Proposes a new, prognostically relevant definition of periprocedural MI after revascularization to better guide clinical trials, patient care, and quality assessment.
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 the 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 using 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.
“Widespread adoption of an 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.”
Moussa et al. (Tue,) conducted a review in Myocardial infarction after coronary revascularization. New definition of clinically relevant myocardial infarction was evaluated. A new definition for clinically relevant myocardial infarction after coronary revascularization is proposed, utilizing biomarker thresholds strongly linked to subsequent adverse events.