TY - JOUR
T1 - Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions
T2 - A Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)
AU - Bulluck, Heerajnarain
AU - Paradies, Valeria
AU - Barbato, Emanuele
AU - Baumbach, Andreas
AU - Bøtker, Hans Erik
AU - Capodanno, Davide
AU - De Caterina, Raffaele
AU - Cavallini, Claudio
AU - Davidson, Sean M.
AU - Feldman, Dmitriy N.
AU - Ferdinandy, Péter
AU - Gili, Sebastiano
AU - Gyöngyösi, Mariann
AU - Kunadian, Vijay
AU - Ooi, Sze Yuan
AU - Madonna, Rosalinda
AU - Marber, Michael
AU - Mehran, Roxana
AU - Ndrepepa, Gjin
AU - Perrino, Cinzia
AU - Schüpke, Stefanie
AU - Silvain, Johanne
AU - Sluijter, Joost P.G.
AU - Tarantini, Giuseppe
AU - Toth, Gabor G.
AU - Van Laake, Linda W.
AU - Von Birgelen, Clemens
AU - Zeitouni, Michel
AU - Jaffe, Allan S.
AU - Thygesen, Kristian
AU - Hausenloy, Derek J.
N1 - Publisher Copyright:
© 2021 Published on behalf of the European Society of Cardiology. All rights reserved.
PY - 2021/7/14
Y1 - 2021/7/14
N2 - A substantial number of chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) experience periprocedural myocardial injury or infarction. Accurate diagnosis of these PCI-related complications is required to guide further management given that their occurrence may be associated with increased risk of major adverse cardiac events (MACE). Due to lack of scientific data, the cut-off thresholds of post-PCI cardiac troponin (cTn) elevation used for defining periprocedural myocardial injury and infarction, have been selected based on expert consensus opinions, and their prognostic relevance remains unclear. In this Consensus Document from the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI), we recommend, whenever possible, the measurement of baseline (pre-PCI) cTn and post-PCI cTn values in all CCS patients undergoing PCI. We confirm the prognostic relevance of the post-PCI cTn elevation >5× 99th percentile URL threshold used to define type 4a myocardial infarction (MI). In the absence of periprocedural angiographic flow-limiting complications or electrocardiogram (ECG) and imaging evidence of new myocardial ischaemia, we propose the same post-PCI cTn cut-off threshold (>5× 99th percentile URL) be used to define prognostically relevant 'major' periprocedural myocardial injury. As both type 4a MI and major periprocedural myocardial injury are strong independent predictors of all-cause mortality at 1 year post-PCI, they may be used as quality metrics and surrogate endpoints for clinical trials. Further research is needed to evaluate treatment strategies for reducing the risk of major periprocedural myocardial injury, type 4a MI, and MACE in CCS patients undergoing PCI.
AB - A substantial number of chronic coronary syndrome (CCS) patients undergoing percutaneous coronary intervention (PCI) experience periprocedural myocardial injury or infarction. Accurate diagnosis of these PCI-related complications is required to guide further management given that their occurrence may be associated with increased risk of major adverse cardiac events (MACE). Due to lack of scientific data, the cut-off thresholds of post-PCI cardiac troponin (cTn) elevation used for defining periprocedural myocardial injury and infarction, have been selected based on expert consensus opinions, and their prognostic relevance remains unclear. In this Consensus Document from the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI), we recommend, whenever possible, the measurement of baseline (pre-PCI) cTn and post-PCI cTn values in all CCS patients undergoing PCI. We confirm the prognostic relevance of the post-PCI cTn elevation >5× 99th percentile URL threshold used to define type 4a myocardial infarction (MI). In the absence of periprocedural angiographic flow-limiting complications or electrocardiogram (ECG) and imaging evidence of new myocardial ischaemia, we propose the same post-PCI cTn cut-off threshold (>5× 99th percentile URL) be used to define prognostically relevant 'major' periprocedural myocardial injury. As both type 4a MI and major periprocedural myocardial injury are strong independent predictors of all-cause mortality at 1 year post-PCI, they may be used as quality metrics and surrogate endpoints for clinical trials. Further research is needed to evaluate treatment strategies for reducing the risk of major periprocedural myocardial injury, type 4a MI, and MACE in CCS patients undergoing PCI.
KW - Chronic coronary syndrome
KW - Percutaneous coronary intervention
KW - Periprocedural myocardial infarction
KW - Periprocedural myocardial injury
KW - Type 4a myocardial infarction
UR - https://www.scopus.com/pages/publications/85112125284
U2 - 10.1093/eurheartj/ehab271
DO - 10.1093/eurheartj/ehab271
M3 - Article
C2 - 34059914
AN - SCOPUS:85112125284
SN - 0195-668X
VL - 42
SP - 2630-2642C
JO - European Heart Journal
JF - European Heart Journal
IS - 27
ER -