Periprocedural myocardial infarction in patients undergoing percutaneous coronary intervention

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 investi-gated the mechanisms, predictors, and therapeutic strategies for periprocedural MI. Various definitions of peri-procedural 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 pa-tient management. In the clinical trial setting, only clinically relevant periprocedural MI definitions should be ap-plied 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.(c) 2022 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Automated summary

Percutaneous coronary intervention (PCI) combined with guideline-directed medical therapy can reduce the risks of spontaneous myocardial infarction (MI), urgent revascularization, and angina, but it also increases the risks of periprocedural myocardial injury and MI. The definitions of periprocedural MI vary, resulting in differences in frequency and clinical significance. Accurate diagnosis of clinically-relevant periprocedural MI is crucial for patient management. In clinical trials, only clinically relevant definitions should be used to avoid obscuring meaningful outcomes. This review aims to summarize the mechanisms, predictors, frequency, and prognostic impact of periprocedural MI in patients undergoing PCI and provide the current perspective on this issue.