Table 3

Myocardial Infarction

Peri-procedural MI (<72 h after the index procedure)
 New ischemic symptoms (e.g. chest pain or shortness of breath), or new ischemic signs (e.g. ventricular arrhythmias, new or worsening heart failure, new ST-segment changes, hemodynamic instability, new pathological Q-waves in at least two contiguous leads, imaging evidence of new loss of viable myocardium or new wall motion abnormality) AND
 Elevated cardiac biomarkers (preferable CK-MB) within 72 h after the index procedure, consisting of at least one sample post-procedure with a peak value exceeding 15 x as the upper reference limit for troponin or 5 x for CK-MB. If cardiac biomarkers are increased at baseline (>99th percentile), a further increase in at least 50% post-procedure is required AND the peak value must exceed the previously stated limit
Spontaneous MI (>72 h after the index procedure)
 Any one of the following criteria
 Detection of rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile URL, together with the evidence of myocardial ischemia with at least one of the following:
    Symptoms of ischemia
    ECG changes indicative of new ischemia [new ST-T changes or new left bundle branch block (LBBB)]
    New pathological Q-waves in at least two contiguous leads    Imaging evidence of a new loss of viable myocardium or new wall
motion abnormality
 Sudden, unexpected cardiac death, involving cardiac arrest, often with symptoms suggestive of myocardial ischemia, and accompanied by presumably new ST elevation, or new LBBB, and/ or evidence of fresh thrombus by coronary angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood.
 Pathological findings of an acute myocardial infarction
  • Previously in the original VARC it was 10× and 5× for troponin and CK-MB, respectively.