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Redefining MI After Revascularization

Redefining MI After Revascularization

Numerous definitions for diagnosing myocardial infarction (MI) after coronary revasculariza­tion are currently being used by clinicians. In 2013, the Society for Cardiovascular Angiography and Interven­tions (SCAI) convened an expert panel that proposed new, more meaningful cri­teria for diagnosing MI after PCI or CABG. “Having a standardized MI definition can help clinicians better identify patients with true complications after PCI or CABG who require urgent action,” says Issam D. Moussa, MD, FSCAI, lead author of the SCAI consensus document. “It would also better reflect the quality of coronary revascularization procedures and assist in the design of research trials aimed at developing effective prevention strategies.” New Criteria The new definition of MI differs from existing definitions in several ways, according to Dr. Moussa. “Both diagnose MI by detecting proteins in the blood that are released when the heart muscle is damaged,” he says. “The universal definition calls for a relatively small increase in cardiac troponin (up to five times the normal level), plus confirmation by an ECG, an imaging test, or symptoms. On the other hand, the new SCAI definition calls for a large increase in CK-MB (up to at least 10 times the normal level) in most cases.” If CK-MB is unavailable, SCAI’s new definition calls for a troponin level that is 70 times the normal level. If an ECG provides strong evidence of an MI, then the new definition allows for blood levels of CK-MB that are five times normal and troponin that is 35 times normal. “When patients are diagnosed with an MI, there are important implications to consider,” Dr. Moussa. “These diagnoses could lead to longer hospitalizations,...
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