The Society for Cardiovascular Angiography and Interventions (SCAI) has released a new definition for myocardial infarction (MI) following coronary revascularization aimed at identifying only those events likely to be related to poorer patient outcomes.
In the new criteria -- published as an expert consensus document in Catheterization and Cardiovascular Interventions and the Journal of the American College of Cardiology -- creatine kinase-myocardial band (CK-MB) is the preferred cardiac biomarker over troponin, and much greater elevations are required to define a clinically relevant MI compared with the universal definition of MI proposed in 2007 and revised in 2012.
Also, the new definition uses the same biomarker elevation thresholds to identify MIs following both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), whereas the universal definition has different thresholds for events following the two procedures.
"What we've really tried to emphasize in this classification scheme is the primary link between biomarker elevations and prognosis," according to Gregg Stone, MD, of Columbia University Medical Center and the Cardiovascular Research Foundation in New York City, one of the authors of the document.
"In the universal definition of MI, they even acknowledged that their criteria were arbitrary," Stone said in an interview. "We've tried to reduce the arbitrariness of the cutoff values that we selected so that the researcher, academician, clinician, hospital administrator, etc., can be confident that these levels that we're recommending are the ones that are associated with a worse prognosis for patients suffering periprocedural complications."