《2013年 SCAI：冠脉血运重建术后心肌梗死的新定义》内容预览

Clinical Decision Making

Consideration of a New Definition of Clinically

Relevant Myocardial Infarction After Coronary

Revascularization: An Expert Consensus Document From

the Society for Cardiovascular Angiography and Interventions


MD Numerous definitions have been proposed for the diagnosis of myocardial infarction（MI） after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention（PCI）-related MI （type 4a） and coronary artery bypass grafting （CABG）-related MI （type 5） which are of uncertain prognostic importance. In addition, for both MI types cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious conse quences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than employing an MI definition sensitive for small degrees of myonecrosis （the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences）， it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a “clinically relevant MI.” The present document introduces a new definition for “clinically relevant MI” after coronary revascularization

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