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Peri-procedural myocardial injury can result from clinically relevant procedural complications of percutaneous coronary intervention (PCI) such as distal embolisation, side-branch occlusion and coronary dissection.1 ,2 Measurement of biomarkers, usually either troponin or creatinine phosphokinase myocardial-banding (CK-MB), after such a complicated procedure will usually document myocyte necrosis, and using detailed cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) these areas of myocardial injury can be visualised (figure 1). However, myocardial injury can also be diagnosed by measurement of biomarkers after clinically uneventful routine PCI procedures. While few coronary interventionalists would debate the likely adverse consequences of occluding a large diagonal branch during a PCI to the left anterior descending artery, considerable controversy persists about the relevance of elevated troponin levels in isolation following a clinically uneventful PCI.
Publication of the ‘Universal definition of Myocardial Infarction’ by the joint ESC/ACCF/AHA/WHF task force was valuable in establishing the importance of peri-procedural myocardial infarction (MI) but added to the clinical debate by defining PCI-related MI (MI type …