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 Perrino; Stefanie 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

doi:10.1093/eurheartj/ehab271

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 Perrino

Stefanie 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

Cardiovascular Research

Norfolk and Norwich University Hospitals NHS Foundation Trust
University of East Anglia
Maasstad Hospital
University of Naples Federico II
Onze Lieve Vrouw Hospital
Barts and The London Queen Mary's School of Medicine and Dentistry
Yale University
Arhus Universitetshospital
Universitá di Catania
University of Pisa
Ospedale Santa Maria della Misericordia
UCL University College London
New York-Presbyterian Hospital
Semmelweis University
Pharmahungary Group
Centro Cardiologico Monzino IRCCS
Medical University of Vienna
Medical School
Freeman Hospital
UNSW University of New South Wales
UTHealth University of Texas Health Science Center at Houston
School of Cardiovascular Medicine and Sciences
Queens Medical Centre
Icahn School of Medicine at Mount Sinai
Cardiovascular Research Foundation
Heart Center Munich-Bogenhausen
University of Paris VI - Pierre and Marie Curie University
UMC University Medical Center Utrecht
University of Padua
Medizinische Universität
Thoraxcentrum Twente
University of Twente
Mayo Clinic
National University of Singapore
National Heart Centre Singapore
Yong Loo Lin School of Medicine
Asia University Taiwan

Research output: Contribution to journal › Article › peer-review

117 Citations (Scopus)

Abstract

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 language	English
Pages (from-to)	2630-2642C
Number of pages	13
Journal	European Heart Journal
Volume	42
Issue number	27
DOIs	https://doi.org/10.1093/eurheartj/ehab271
Publication status	Published - 14 Jul 2021

Keywords

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

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Bulluck, H., Paradies, V., Barbato, E., Baumbach, A., Bøtker, H. E., Capodanno, D., De Caterina, R., Cavallini, C., Davidson, S. M., Feldman, D. N., Ferdinandy, P., Gili, S., Gyöngyösi, M., Kunadian, V., Ooi, S. Y., Madonna, R., Marber, M., Mehran, R., Ndrepepa, G., ... Hausenloy, D. J. (2021). 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). European Heart Journal, 42(27), 2630-2642C. https://doi.org/10.1093/eurheartj/ehab271

Bulluck, Heerajnarain ; Paradies, Valeria ; Barbato, Emanuele et al. / 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). In: European Heart Journal. 2021 ; Vol. 42, No. 27. pp. 2630-2642C.

@article{525220f703a74d648740fae1ce217932,

title = "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)",

abstract = "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.",

keywords = "Chronic coronary syndrome, Percutaneous coronary intervention, Periprocedural myocardial infarction, Periprocedural myocardial injury, Type 4a myocardial infarction",

author = "Heerajnarain Bulluck and Valeria Paradies and Emanuele Barbato and Andreas Baumbach and B{\o}tker, \{Hans Erik\} and Davide Capodanno and \{De Caterina\}, Raffaele and Claudio Cavallini and Davidson, \{Sean M.\} and Feldman, \{Dmitriy N.\} and P{\'e}ter Ferdinandy and Sebastiano Gili and Mariann Gy{\"o}ngy{\"o}si and Vijay Kunadian and Ooi, \{Sze Yuan\} and Rosalinda Madonna and Michael Marber and Roxana Mehran and Gjin Ndrepepa and Cinzia Perrino and Stefanie Sch{\"u}pke and Johanne Silvain and Sluijter, \{Joost P.G.\} and Giuseppe Tarantini and Toth, \{Gabor G.\} and \{Van Laake\}, \{Linda W.\} and \{von Birgelen\}, Clemens and Michel Zeitouni and Jaffe, \{Allan S.\} and Kristian Thygesen and Hausenloy, \{Derek J.\}",

note = "Funding Information: AB is supported by the Barts NIHR Cardiovascular Biomedical Research Centre. HEB was funded by the Novo Nordisk Foundation (grant numbers NNF14OC0013337, NNF15OC0016674), The Danish Council for Strategic Research (11-108354), and Trygfonden (109624). DC was supported by Ministero dell'Universit? e della Ricerca, Progetti di Rilevante Interesse Nazionale (PRIN 2017 - 2017N8K7S2). SD was supported by the National Institute for Health Research Biomedical Research Centre (NIHR-BRC) (BRC233/CM/SD/101320) and the British Heart Foundation (PG/18/ 44/33790 and PG/16/85/32471). PF was supported by the National Research, Development and Innovation Office of Hungary (Research Excellence Program - TKP/FIKP, National Heart Program NVKP 16- 1-2016-0017). VK is supported by the British Heart Foundation Clinical Study Grant (CS/15/7/316), Newcastle NIHR Biomedical Research Centre, and Institutional Research Grant from Astra Zeneca (ISSBRIL0303). MM is supported by the National Institute for Health Research comprehensive Biomedical Research Centre award to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. CP was supported by Ministero dell'Istruzione, Universit? e Ricerca Scientifica (2015583WMX) and by Programma STAR, Federico II University (Unina) and Compagnia di San Paolo. LL was supported by the Netherlands Heart Foundation (Dekker Senior Clinical Scientist). JPGS is supported by Horizon2020 ERC-2016-COG EVICARE (725229). DJH was supported by the Duke-National University Singapore Medical School, Singapore Ministry of Health's National Medical Research Council under its Clinician Scientist-Senior Investigator scheme (NMRC/CSASI/ 0011/2017) and Collaborative Centre Grant scheme (NMRC/ CGAug16C006). DJH, SD, PF, and MG are members of the COST Action EU-CARDIOPROTECTION CA16225 supported by COST (European Cooperation in Science and Technology). Publisher Copyright: {\textcopyright} 2021 Published on behalf of the European Society of Cardiology. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = jul,

day = "14",

doi = "10.1093/eurheartj/ehab271",

language = "English",

volume = "42",

pages = "2630--2642C",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "27",

}

Bulluck, H, Paradies, V, Barbato, E, Baumbach, A, Bøtker, HE, Capodanno, D, De Caterina, R, Cavallini, C, Davidson, SM, Feldman, DN, Ferdinandy, P, Gili, S, Gyöngyösi, M, Kunadian, V, Ooi, SY, Madonna, R, Marber, M, Mehran, R, Ndrepepa, G, Perrino, C, Schüpke, S, Silvain, J, Sluijter, JPG, Tarantini, G, Toth, GG, Van Laake, LW, von Birgelen, C, Zeitouni, M, Jaffe, AS, Thygesen, K & Hausenloy, DJ 2021, '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)', European Heart Journal, vol. 42, no. 27, pp. 2630-2642C. https://doi.org/10.1093/eurheartj/ehab271

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). / Bulluck, Heerajnarain; Paradies, Valeria; Barbato, Emanuele et al.
In: European Heart Journal, Vol. 42, No. 27, 14.07.2021, p. 2630-2642C.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions

T2 - a Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

AU - Bulluck, Heerajnarain

AU - Paradies, Valeria

AU - Barbato, Emanuele

AU - Baumbach, Andreas

AU - Bøtker, Hans Erik

AU - Capodanno, Davide

AU - De Caterina, Raffaele

AU - Cavallini, Claudio

AU - Davidson, Sean M.

AU - Feldman, Dmitriy N.

AU - Ferdinandy, Péter

AU - Gili, Sebastiano

AU - Gyöngyösi, Mariann

AU - Kunadian, Vijay

AU - Ooi, Sze Yuan

AU - Madonna, Rosalinda

AU - Marber, Michael

AU - Mehran, Roxana

AU - Ndrepepa, Gjin

AU - Perrino, Cinzia

AU - Schüpke, Stefanie

AU - Silvain, Johanne

AU - Sluijter, Joost P.G.

AU - Tarantini, Giuseppe

AU - Toth, Gabor G.

AU - Van Laake, Linda W.

AU - von Birgelen, Clemens

AU - Zeitouni, Michel

AU - Jaffe, Allan S.

AU - Thygesen, Kristian

AU - Hausenloy, Derek J.

N1 - Funding Information: AB is supported by the Barts NIHR Cardiovascular Biomedical Research Centre. HEB was funded by the Novo Nordisk Foundation (grant numbers NNF14OC0013337, NNF15OC0016674), The Danish Council for Strategic Research (11-108354), and Trygfonden (109624). DC was supported by Ministero dell'Universit? e della Ricerca, Progetti di Rilevante Interesse Nazionale (PRIN 2017 - 2017N8K7S2). SD was supported by the National Institute for Health Research Biomedical Research Centre (NIHR-BRC) (BRC233/CM/SD/101320) and the British Heart Foundation (PG/18/ 44/33790 and PG/16/85/32471). PF was supported by the National Research, Development and Innovation Office of Hungary (Research Excellence Program - TKP/FIKP, National Heart Program NVKP 16- 1-2016-0017). VK is supported by the British Heart Foundation Clinical Study Grant (CS/15/7/316), Newcastle NIHR Biomedical Research Centre, and Institutional Research Grant from Astra Zeneca (ISSBRIL0303). MM is supported by the National Institute for Health Research comprehensive Biomedical Research Centre award to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London. CP was supported by Ministero dell'Istruzione, Universit? e Ricerca Scientifica (2015583WMX) and by Programma STAR, Federico II University (Unina) and Compagnia di San Paolo. LL was supported by the Netherlands Heart Foundation (Dekker Senior Clinical Scientist). JPGS is supported by Horizon2020 ERC-2016-COG EVICARE (725229). DJH was supported by the Duke-National University Singapore Medical School, Singapore Ministry of Health's National Medical Research Council under its Clinician Scientist-Senior Investigator scheme (NMRC/CSASI/ 0011/2017) and Collaborative Centre Grant scheme (NMRC/ CGAug16C006). DJH, SD, PF, and MG are members of the COST Action EU-CARDIOPROTECTION CA16225 supported by COST (European Cooperation in Science and Technology). Publisher Copyright: © 2021 Published on behalf of the European Society of Cardiology. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/7/14

Y1 - 2021/7/14

N2 - 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.

AB - 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.

KW - Chronic coronary syndrome

KW - Percutaneous coronary intervention

KW - Periprocedural myocardial infarction

KW - Periprocedural myocardial injury

KW - Type 4a myocardial infarction

UR - https://www.scopus.com/pages/publications/85112125284

U2 - 10.1093/eurheartj/ehab271

DO - 10.1093/eurheartj/ehab271

M3 - Article

C2 - 34059914

AN - SCOPUS:85112125284

SN - 0195-668X

VL - 42

SP - 2630-2642C

JO - European Heart Journal

JF - European Heart Journal

IS - 27

ER -

Bulluck H, Paradies V, Barbato E, Baumbach A, Bøtker HE, Capodanno D et al. 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). European Heart Journal. 2021 Jul 14;42(27):2630-2642C. doi: 10.1093/eurheartj/ehab271

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)

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