title: Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization: an expert consensus document from the Society for Cardiovascular Angiography and Interventions (SCAI).
abstract: 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.
authors.affiliation: Mayo Clinic, Jacksonville, Florida. Electronic address: moussa.issam@mayo.edu.
authors.forename: Issam D
authors.initials: ID
authors.lastname: Moussa
authors.forename: Lloyd W
authors.initials: LW
authors.lastname: Klein
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mack
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: John P
authors.initials: JP
authors.lastname: Reilly
authors.forename: Gilbert
authors.initials: G
authors.lastname: Zoghbi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holper
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography / Q000379:methods / Q000592:standards*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D009204:Myocardial Revascularization / Q000009:adverse effects*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D012955:Societies, Medical / Q000592:standards*
chemical_list: D015415:Biomarkers
keywords: ACS; CABG; LGE; MI; PCI; acute coronary syndrome(s); cMRI; cardiac biomarkers; cardiac magnetic resonance imaging; coronary artery bypass graft; coronary revascularization; late gadolinium enhancement; myocardial infarction; myocardial infarction definition; percutaneous coronary intervention