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PURPOSE

This review intends to illustrate basic principles on how to apply the Fourth Universal Definition of Myocardial Infarction (UDMI) for the diagnosis of peri-procedural myocardial infarction (MI) after percutaneous coronary interventions (PCI) in clinical practice.

METHODS AND RESULTS

Review of routine case-based events. Increases in cardiac troponin (cTn) concentrations are common after elective PCI in patients with chronic coronary syndrome (CCS). Peri-procedural PCI-related MI (type 4a MI) in CCS patients should be diagnosed in cases of major peri-procedural acute myocardial injury indicated by an increase in cTn concentrations of >5-times the 99th percentile upper reference limit (URL) together with evidence of new peri-procedural myocardial ischaemia as demonstrated by electrocardiography (ECG), imaging, or flow-limiting peri-procedural complications in coronary angiography. Measurement of cTn baseline concentrations before elective PCI is useful. In patients presenting with acute MI undergoing PCI, peri-procedural increases in cTn concentrations are usually due to their index presentation and not PCI-related, apart from obvious major peri-procedural complications, such as persistent occlusion of a large side branch or no-reflow after stent implantation.

CONCLUSION

The distinction between type 4a MI, PCI-related acute myocardial injury, and chronic myocardial injury can be challenging in individuals undergoing PCI. Careful integration of all available clinical data is essential for correct classification.

目的

本文旨在阐述如何将第四版心肌梗死通用定义（UDMI）应用于经皮冠状动脉介入治疗（PCI）后围手术期心肌梗死（MI）的诊断，以指导临床实践。

方法和结果

回顾基于常规病例的事件。在慢性冠状动脉综合征（CCS）患者接受择期 PCI 后，心肌肌钙蛋白（cTn）浓度升高较为常见。CCS 患者的围手术期 PCI 相关 MI（4a 型 MI）应诊断为 cTn 浓度较第 99 百分位 URL 上限升高>5 倍，并伴有心电图（ECG）、影像学或冠状动脉造影显示新的围手术期心肌缺血证据的主要围手术期急性心肌损伤。在择期 PCI 前测量 cTn 基线浓度有助于诊断。对于因急性 MI 而行 PCI 的患者，cTn 浓度的围手术期升高通常归因于其首发表现，而不是 PCI 相关，除非存在明显的主要围手术期并发症，如大分支持续闭塞或支架植入后无复流。