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).

Issam D. Moussa, Lloyd W. Klein, Binita Shah, Roxana Mehran, Michael J. Mack, Emmanouil S. Brilakis, John P. Reilly, Gilbert Zoghbi, Elizabeth Holper, Gregg W. Stone, for Cardiovascular Angiography Society for Cardiovascular Angiography

Research output: Contribution to journalArticle

34 Citations (Scopus)

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 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 employing 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 languageEnglish (US)
Pages (from-to)27-36
Number of pages10
JournalCatheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Volume83
Issue number1
StatePublished - Jan 1 2014

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Consensus
Myocardial Infarction
Biomarkers
Percutaneous Coronary Intervention
Coronary Artery Bypass
Critical Pathways
Mental Competency
Patient Care
Heart Failure
Outcome Assessment (Health Care)
Clinical Trials
Physicians
Equipment and Supplies
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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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.; Society for Cardiovascular Angiography, for Cardiovascular Angiography.

In: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Vol. 83, No. 1, 01.01.2014, p. 27-36.

Research output: Contribution to journalArticle

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. ; Society for Cardiovascular Angiography, for Cardiovascular Angiography. / 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). In: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2014 ; Vol. 83, No. 1. pp. 27-36.
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