Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: A Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Heerajnarain Bulluck, Valeria Paradies, Emanuele Barbato, Andreas Baumbach, Hans Erik Bøtker, Davide Capodanno, Raffaele de Caterina, Claudio Cavallini, Sean M. Davidson, Dmitriy N. Feldman, Péter Ferdinandy, Sebastiano Gili, Mariann Gyöngyösi, Vijay Kunadian, Sze-Yuan Ooi, Rosalinda Madonna, Michael Marber, Roxana Mehran, Gjin Ndrepepa, Cinzia PerrinoStefanie Schüpke, Johanne Silvain, Joost P. G. Sluijter, Giuseppe Tarantini, Gabor G. Toth, Linda W. van Laake, Clemens von Birgelen, Michel Zeitouni, Allan S. Jaffe, Kristian Thygesen, Derek J. Hausenloy

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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.

Original languageEnglish
Pages (from-to)2630–2642
Number of pages13
JournalEuropean Heart Journal
Issue number27
Early online date31 May 2021
Publication statusPublished - 14 Jul 2021


  • Chronic coronary syndrome
  • Percutaneous coronary intervention
  • Periprocedural myocardial infarction
  • Periprocedural myocardial injury
  • Type 4a myocardial infarction

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