Author + information
- Issam D. Moussa, MD∗∗ (, )
- Lloyd W. Klein, MD†,
- Binita Shah, MD‡,
- Roxana Mehran, MD§,
- Michael J. Mack, MD‖,
- Emmanouil S. Brilakis, MD¶,
- John P. Reilly, MD#,
- Gilbert Zoghbi, MD∗∗,
- Elizabeth Holper, MD†† and
- Gregg W. Stone, MD‡‡
- ∗Mayo Clinic, Jacksonville, Florida
- †Rush University, Division of Cardiology, Department of Medicine, Chicago, Illinois
- ‡New York University School of Medicine, New York, New York
- §Mount Sinai Medical Center, Division of Cardiology, New York, New York
- ‖Baylor HealthCare System, Dallas, Texas
- ¶VA North Texas Healthcare System and UT Southwestern Medical School, Dallas, Texas
- #Oschner Clinic, New Orleans, Louisiana
- ∗∗Stern Cardiovascular Foundation, Memphis, Tennessee
- ††Medical City Dallas Hospital, Dallas, Texas
- ‡‡Columbia University Medical Center, New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York City, New York
- ↵∗Reprint requests and correspondence:
Dr. Issam D. Moussa, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224.
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.
Dr. Shah has received a research grant from Guerbet. Dr. Mehran is a consultant for The Medicines Company, BMS/Sanofi, Merck, Maya Medical, AstraZeneca, Merck, Abbott Vascular, Regado Biosciences, and Janssen Pharma; and has received grants or research support from Lilly/Daiichi Sankyo, The Medicines Company, and BMS/Sanofi. Dr. Brilakis is on the speakers’ bureau for St. Jude Medical, Medtronic, and Terumo; has received research grants from Guerbet; has received honoraria from St. Jude Medical, Terumo, and Bridgepoint/Boston Scientific; and his spouse is an employee of Medtronic. Dr. Reilly is a consultant for Gilead; and is on the speakers’ bureau for AstraZeneca and Eli Lilly/DSI. Dr. Holper is on the speakers’ bureau for Boston Scientific. Dr. Stone is a consultant for Boston Scientific, Eli Lilly, Daiichi Sankyo, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 12, 2013.
- Accepted July 13, 2013.
- Pathophysiology of Peri-Procedural Myonecrosis, and the Potential for Confounding
- Importance of Pre-Procedure Cardiac Biomarker Elevation
- cTn Versus CK-MB Elevation After Coronary Revascularization
- Insight From Cardiac Magnetic Resonance Imaging Studies
- Recommendation for a Definition of “Clinically Relevant MI” After Coronary Revascularization
- Post-CABG Myocardial Infarction
- Limitations and Future Directions