Cardiac troponin elevation after elective PCI: adding infarct to major injury

This editorial refers to ‘Cardiac procedural myocardial injury, infarction, and mortality in patients undergoing elective percutaneous coronary intervention: a pooled analysis of patient-level data’†, by J. Silvain et al., on page 323. The diagnosis of myocardial injury or myocardial infarction (MI) following coronary revascularization is complicated by a heterogeneous abundance of published definitions.1–5 Achieving consensus has been challenging due to the uncertain clinical importance of procedural myocardial injury of varying magnitude. Seemingly conflicting results between studies may be driven by the variable presence of myocardial injury prior to coronary revascularization, the wide range of sensitivity of assays, and the potential for confounded relationships between procedural biomarker elevations and underlying patient substrate. Moreover, the overall low event rates in patients with chronic coronary syndrome (CCS) who have undergone elective percutaneous coronary intervention (PCI) necessitate very large sample sizes to reliably study this risk relationship. In this...