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.