@article {Leonardi1282, author = {Sergio Leonardi and Adriano A M Truffa and Megan L Neely and Pierluigi Tricoci and Harvey D White and C Michael Gibson and Matthew Wilson and Gregg W Stone and Robert A Harrington and Deepak L Bhatt and Kenneth W Mahaffey}, title = {A novel approach to systematically implement the universal definition of myocardial infarction: insights from the CHAMPION PLATFORM trial}, volume = {99}, number = {17}, pages = {1282--1287}, year = {2013}, doi = {10.1136/heartjnl-2012-303103}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective To reassess the efficacy of cangrelor efficacy using the universal definition of myocardial infarction (MI). Design We adopted a novel approach to systematically implement the universal definition of MI. Two physicians blinded to treatment allocation reviewed plots of CK-MB and troponin values in relation to time of randomisation and percutaneous coronary intervention (PCI) to identify patients with stable or falling biomarkers pre-PCI (ie, primary cohort), and those with post-PCI CK-MB elevations. Setting The CHAMPION PLATFORM trial. Patients Non-ST-elevation acute coronary syndromes (95\%) and stable angina patients (5\%). Interventions Cangrelor versus placebo. Main outcome measures The efficacy of cangrelor compared with placebo using the reclassified events (type 4a MI) and the original clinical events committee-adjudicated (CEC PCI-MI) results was investigated. Results Of 5295 patients, 3406 (64.4\%) were in the primary cohort. Type 4a MI occurred in 4.3\% (226 events/5295 patients) while original CEC PCI-MI occurred in 6.5\% (344 events/5295 patients), a significant difference (p\<0.0001). Using the reclassified MI events, the primary composite endpoint of death, MI, or ischaemia-driven revascularisation through 48 h occurred in 5.4\% of patients (4.9\% cangrelor, 6.0\% placebo; OR 0.80; 95\% CI 0.63 to 1.02) as opposed to 7.5\% of the primary analyses (7.0\% cangrelor, 8.0\% placebo; OR 0.87; 95\% CI 0.71 to 1.07). Conclusions Systematic, strict implementation of the universal MI definition with emphasis on baseline assessment may enhance discrimination in detecting PCI-MI and may allow for more rigorous assessment of interventions in patients undergoing early PCI.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/99/17/1282}, eprint = {https://heart.bmj.com/content/99/17/1282.full.pdf}, journal = {Heart} }