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Periprocedural Myocardial Infarction: Do We Need an Updated Definition?
Marcello Casuso Alvarez1,2, Leonardo Luca Bavuso1,2, Michele Di Leo1,2
1Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy.
Journal of Cardiovascular Development and Disease
|March 27, 2026
Summary
Defining periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) is challenging. This review compares current definitions and suggests improvements for accurate MI diagnosis in PCI patients.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Periprocedural myocardial infarction (MI) after percutaneous coronary intervention (PCI) is debated.
- High-sensitivity cardiac troponin assays frequently detect biomarker rises without significant ischemia.
Purpose of the Study:
- Critically examine current frameworks for defining periprocedural MI.
- Compare biomarker thresholds, ischemia evidence, and procedural criteria.
- Identify limitations and propose future directions for definition harmonization.
Main Methods:
- Review of contemporary definitions: Fourth Universal Definition of Myocardial Infarction (UDMI), Academic Research Consortium (ARC)-2, and Society for Cardiovascular Angiography and Interventions (SCAI).
- Analysis of pathophysiologic mechanisms of myocardial injury during PCI.
- Evaluation of limitations in current diagnostic criteria.
Main Results:
- Differences in definitions impact reported event rates and study heterogeneity.
- Mechanisms include side-branch compromise, embolization, microvascular dysfunction, and mechanical complications.
- Limitations include assay variability, inconsistent timing, unreliable ancillary criteria, and weak biomarker-outcome correlation.
Conclusions:
- Current definitions for periprocedural MI after PCI have significant limitations.
- Harmonizing biomarker thresholds and emphasizing relative biomarker dynamics are crucial.
- Integrating biomarkers with objective ischemic evidence will improve diagnostic specificity and clinical relevance.
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