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Periprocedural Myocardial Infarction After Coronary Artery Bypass Grafting: Current Clinical Practices and Future
Brian Swinnen1,2,3, Jules R Olsthoorn4,5, Casper Mihl2,3
1Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
Insights
Definitions for periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG) lack standardization. This survey highlights the need for a consensus-based, CABG-specific PMI definition to ensure consistent clinical diagnosis and communication.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Diagnostics
Background:
- Definitions of periprocedural myocardial infarction (PMI) following coronary artery bypass grafting (CABG) are inconsistent and debated.
- Lack of a standardized definition hinders accurate diagnosis and communication in clinical practice.
Purpose of the Study:
- To conduct an international survey endorsed by the European Association for Cardiothoracic Surgery (EACTS) to assess current practices regarding PMI definitions.
- To achieve a consensus on diagnostic characteristics for a future, standardized PMI definition after CABG.
Main Methods:
- A questionnaire, adhering to the CHERRIES guideline, was developed and pilot-tested.
- The survey was distributed to EACTS members and allied specialists between August and November 2024, evaluating definitions, biomarkers, and diagnostic accuracy requirements.
- 175 respondents from 29 countries completed the survey.
Main Results:
- Current PMI definitions vary, with the Universal Definition of Myocardial Infarction (UDMI)-4 being the most frequently used (67.4%).
- Respondents provided specific biomarker concentration thresholds for diagnosing PMI, both with and without supporting imaging evidence.
- For a future definition, the lowest acceptable sensitivity and specificity were 95% and 90%, respectively, with sensitivity prioritized over specificity.
Conclusions:
- Significant variation exists in the application of PMI definitions post-CABG.
- A standardized, CABG-specific PMI definition with high diagnostic accuracy is crucial for consistent diagnoses and a unified clinical language.
Objectives:
The definitions of periprocedural myocardial infarction (PMI) after coronary artery bypass grafting (CABG) are heavily debated. A European Association for Cardiothoracic Surgery (EACTS)-endorsed international survey was conducted to evaluate current clinical practices and to reach a consensus-based agreement on the diagnostic characteristics required for a potential future PMI definition.
Methods:
The questionnaire complied with the CHERRIES guideline. A pilot version underwent iterative testing. The final version was distributed to all members of EACTS and allied specialties. The questionnaire evaluated definitions, biomarkers, and required diagnostic accuracy and was distributed between August-November 2024.
Results:
The questionnaire was completed by 175 respondents (surgeons: 71.4%, cardiologists: 20.6%, intensivists: 5.1%, other: 2.9%) from 29 countries. A specific definition of PMI was used by 46.4% of respondents (Universal Definition of Myocardial Infarction [UDMI]-4: 67.4%, Society of Cardiovascular Angiography and Interventions [SCAI]: 16.3%, second Academic Research Consortium [ARC-2]: 6.1%, other: 10.2%). Respondents identified biomarker concentrations defining PMI with supporting (imaging) evidence (high-sensitivity cardiac troponin T [hs-cTnT]: 489 ng/L, high-sensitivity cardiac troponin I [hs-cTnI]: 425 ng/L, CKMB-mass: 90ug/L, CKMB-activity: 100 U/L) and without (hs-cTnT: 931 ng/L, hs-cTnI: 1458 ng/L, CKMB-mass: 100ug/L, CKMB-activity: 300UL). The lowest acceptable sensitivity and specificity thresholds for a future definition were 95% [90%-95%] and 90% [80%-95%], respectively, while sensitivity was deemed more important than specificity (79.8% vs 20.2%, P < .001).
Conclusions:
The use of PMI definitions varies widely, though UDMI-4 is most frequently employed. Our findings highlight the need for a standardized, CABG-specific PMI definition with robust diagnostic accuracy to enable consistent diagnoses and a common clinical language.
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