Research Article| Volume 96, P17-19, February 2022

Procedural myocardial infarction and major myocardial injury after percutaneous coronary interventions in chronic coronary syndrome: Is the fog really waning?

Published:November 18, 2021DOI:


      • The impact of procedural myocardial infarction (MI) is matter of controversy.
      • Type 4a MI is significantly associated with mortality.
      • Including “stand-alone MI” in procedural MI weakens its prognostic value.
      • Evidence does not support other than type 4a MI as endpoint in clinical trials.


      The prognostic role of procedural myocardial infarction (MI) is still controversial and matter of ongoing debate in the scientific community. A recent ESC Consensus Document confirmed the prognostic importance of type 4a MI and defined equally clinically relevant the major peri‑procedural myocardial injury, defined as the same cardiac Troponin cut-off threshold of type 4a MI without peri‑procedural angiographic complications, electrocardiographic or imaging evidence of new myocardial ischaemia. In the present manuscript we discuss available data supporting this paradigm shift and discuss some drawbacks which should be taken into account in interpreting the results. In light of recent mounting evidence, we challenge the prognostic relevance of major periprocedural myocardial injury, suggesting that type 4a MI should be the only definition for procedural MI to be used as an endpoint in clinical trials.

      Graphical abstract

      MI (Myocardial Infarction), PCI (Percutaneous Coronary Intervention), URL (Upper Reference Limit), cTn (Cardiac Troponin), ESC (European Society of Cardiology), CCS (Chronic Coronary Syndrome)


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