title: New universal definition of myocardial infarction applicable after complex percutaneous coronary interventions?
abstract: OBJECTIVE
  This study aimed to characterize myocardial infarction after percutaneous coronary intervention (PCI) based on cardiac marker elevation as recommended by the new universal definition and on the detection of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). It is also assessed whether baseline inflammatory biomarkers are higher in patients developing myocardial injury.
  
  
  BACKGROUND
  Cardiovascular magnetic resonance accurately assesses infarct size. Baseline C-reactive protein (CRP) and neopterin predict prognosis after stent implantation.
  
  
  METHODS
  Consecutive patients with baseline troponin (Tn) I within normal limits and no LGE in the target vessel underwent baseline and post-PCI CMR. The Tn-I was measured until 24 h after PCI. Serum high-sensitivity CRP and neopterin were assessed before coronary angiography.
  
  
  RESULTS
  Of 45 patients, 64 (53 to 72) years of age, 33% developed LGE with infarct size of 0.83 g (interquartile range: 0.32 to 1.30 g). A Tn-I elevation >99% upper reference limit (i.e., myocardial necrosis) (median Tn-I: 0.51 μg/l, interquartile range: 0.16 to 1.23) and Tn-I > 3× upper reference limit (i.e., type 4a myocardial infarction [MI]) occurred in 58% and 47% patients, respectively. LGE was undetectable in 42% and 43% of patients with periprocedural myocardial necrosis and type 4a MI, respectively. Agreement between LGE and type 4a MI was moderate (kappa = 0.45). The levels of CRP or neopterin did not significantly differ between patients with or without myocardial injury, detected by CMR or according to the new definition (p = NS).
  
  
  CONCLUSIONS
  This study reports the lack of substantial agreement between the new universal definition and CMR for the diagnosis of small-size periprocedural myocardial damage after complex PCI. Baseline levels of CRP or neopterin were not predictive for the development of periprocedural myocardial damage.
authors.affiliation: CMR Unit, Royal Brompton Hospital, London; Imperial College, London, UK. c.dimario@rbht.nhs.uk
authors.forename: Didier
authors.initials: D
authors.lastname: Locca
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucciarelli-Ducci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ferrante
authors.forename: Alessio
authors.initials: A
authors.lastname: La Manna
authors.forename: Niall G
authors.initials: NG
authors.lastname: Keenan
authors.forename: Agata
authors.initials: A
authors.lastname: Grasso
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
authors.forename: Francesca
authors.initials: F
authors.lastname: Del Furia
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Kaski
authors.forename: Dudley J
authors.initials: DJ
authors.lastname: Pennell
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D019798:Neopterin / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019798:Neopterin; D002097:C-Reactive Protein