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, Kristian Thygesen Department of Cardiology, Aarhus University Hospital , Aarhus, Denmark Corresponding author. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark. Tel: +45-40444892; e-mail: kthygesen@oncable.dk (K. Thygesen). Search for other works by this author on: Oxford Academic Allan S Jaffe Department of Cardiology, Mayo Clinic and Medical School , Rochester, MN, USA Department of Laboratory Medicine and Pathology, Mayo Clinic and Medical School , Rochester, MN, USA Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0002-3674-1308 European Journal of Cardio-Thoracic Surgery, Volume 65, Issue 4, April 2024, ezae130, https://doi.org/10.1093/ejcts/ezae130
Published:
01 April 2024
Article history
Received:
27 December 2023
Revision received:
21 March 2024
Accepted:
28 March 2024
Published:
01 April 2024
Corrected and typeset:
13 April 2024
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Kristian Thygesen, Allan S Jaffe, A call for universal definition of myocardial infarction after cardiac surgery, European Journal of Cardio-Thoracic Surgery, Volume 65, Issue 4, April 2024, ezae130, https://doi.org/10.1093/ejcts/ezae130
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Defining concepts that enable clinicians and patients to communicate effectively concerning myocardial infarction associated with cardiac surgery requires an accurate, clear and easily interpreted definition. If the diagnostic criteria are accurate and reproducible, it will facilitate clinical care and clinical trials. Furthermore, it would allow for results from 1 clinical trial to be compared and even combined with the results of other trials.
Unfortunately, the ideal world of a universally understood and applied definition does not exist in the domain of procedure-related myocardial infarction (PMI). Over the years differing definitions using different diagnostic tools have been employed and consequently, it is often a challenge to compare the ‘apples’ in 1 study to the ‘oranges’ in another. Thus, studies involving large databases employing hospital discharge diagnoses often contain significant inaccuracies since the definitions of PMI employed are highly variable.
The fundamental definitional principles initially were developed without regard for prognostic reflections although it is well established that any increase in cardiac troponin is almost invariably associated with an adverse prognosis [1]. Recently, as more data has accumulated, there has been an appropriate and increasing interest in examining the outcomes of components of the PMI definition to consider not only of diagnostic accuracy but also clinical relevance. In this context, cohort analyses have shown substantial differences in the rates and clinical significance of PMI depending on the criteria applied and the nature of the biomarkers and the assays used to measure them. Various diagnostic cut-offs, with or without ancillary criteria can provide very different rates of PMI after coronary artery bypass grafting (CABG) [2, 3].
Subject
Minimally Invasive Procedures (Acquired Cardiac) Myocardial Infarction Organ Protection (Acquired Cardiac)
Issue Section:
GENERAL ADULT CARDIAC
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See also
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Commentary
- European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery
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