Periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention

• Published in: Journal of cardiology 2023-04, Vol.81 (4), p.364-372
• Main Authors: Ueki, Yasushi, Kuwahara, Koichiro
• Format: Article
• Language: English
• Subjects: Angina Pectoris; Chronic coronary syndrome; Coronary Artery Disease - complications; Humans; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - etiology; Myocardial Infarction - therapy; Myocardial injury; Myocardial Ischemia - complications; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Risk Factors; Treatment Outcome
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2022.11.005

Percutaneous coronary intervention (PCI) in addition to guideline-directed medical therapy reduces the risk of spontaneous myocardial infarction (MI), urgent revascularization, and improves angina status; however, PCI is associated with an increased risk of periprocedural myocardial injury and MI. Numerous studies have investigated the mechanisms, predictors, and therapeutic strategies for periprocedural MI. Various definitions of periprocedural MI have been proposed by academic groups and professional societies requiring different cardiac biomarker thresholds and ancillary criteria for myocardial ischemia. The frequency and clinical significance of periprocedural MI substantially varies according to the definitions applied. In daily practice, accurate diagnosis of clinically-relevant periprocedural MI is essential because it may have a substantial impact on subsequent patient management. In the clinical trial setting, only clinically relevant periprocedural MI definitions should be applied as a clinical endpoint in order to avoid obscuring meaningful outcomes. In this review, we aim to summarize the mechanisms, predictors, frequency, and prognostic impact of periprocedural MI in patients undergoing PCI and to provide the current perspective on this issue. [Display omitted] •Periprocedural MI remains frequent following PCI among patients with CCS.•Identification of risk factors for periprocedural MI may be useful to mitigate the risk of periprocedural complication.•The UDMI applied the lower threshold with cTn and more broadly-defined ancillary criteria compared with the SCAI and ARC-2.•The frequency and prognostic impact of periprocedural MI varies considerably according to the definitions applied.•The clinically relevant definitions should be considered for use in daily practice and clinical trials.