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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1563-1570 |
| Number of pages | 8 |
| Journal | Journal of the American College of Cardiology |
| Volume | 62 |
| Issue number | 17 |
| DOIs | |
| State | Published - Oct 22 2013 |
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Keywords
- cardiac biomarkers
- coronary revascularization
- myocardial infarction definition
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
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). / Moussa, Issam D.; Klein, Lloyd W.; Shah, Binita; Mehran, Roxana; Mack, Michael J.; Brilakis, Emmanouil S.; Reilly, John P.; Zoghbi, Gilbert; Holper, Elizabeth; Stone, Gregg W.
In: Journal of the American College of Cardiology, Vol. 62, No. 17, 22.10.2013, p. 1563-1570.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Consideration of a new definition of clinically relevant myocardial infarction after coronary revascularization
T2 - An expert consensus document from the society for cardiovascular angiography and interventions (SCAI)
AU - Moussa, Issam D.
AU - Klein, Lloyd W.
AU - Shah, Binita
AU - Mehran, Roxana
AU - Mack, Michael J.
AU - Brilakis, Emmanouil S.
AU - Reilly, John P.
AU - Zoghbi, Gilbert
AU - Holper, Elizabeth
AU - Stone, Gregg W.
PY - 2013/10/22
Y1 - 2013/10/22
N2 - 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.
AB - 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.
KW - cardiac biomarkers
KW - coronary revascularization
KW - myocardial infarction definition
UR - http://www.scopus.com/inward/record.url?scp=84886003933&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84886003933&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.08.720
DO - 10.1016/j.jacc.2013.08.720
M3 - Article
C2 - 24135581
AN - SCOPUS:84886003933
VL - 62
SP - 1563
EP - 1570
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 17
ER -