Troponins in the definition of myocardial infarction after percutaneous coronary interventions

The recently updated Universal Definition of Myocardial infarction (MI) arbitrarily defined periprocedural MI (type 4a) by elevation of cardiac troponin (cTn) values >5 x the upper reference limit (URL) in patients with normal baseline values or a rise of cTn values >20% if the baseline values are elevated, together with either angina or new ECG changes or angiographic loss of patency of a coronary artery or a side branch or persistent slow or no-flow or embolization, or imaging demonstration of new loss of viable myocardium. Although an association between CK-MB elevations and adverse prognosis after PCI has been documented, existing data do not however support the statement that an isolated elevation of cTn after PCI is associated with an adverse prognosis after PCI; increased cTn levels before PCI seem far more predictive of future events than a periprocedural increase itself. Caution should be paid in the interpretation of clinical trials using type 4a MI as a primary endpoint. Nevertheless, patients with periprocedural myocardial damage should be treated as a higher-risk cohort, carefully monitored and receive an intensified secondary prevention program. (C) 2013 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp.zo.o. All rights reserved.