Causes of coronary procedure related myocardial infarction

Causes of coronary procedure related myocardial infarction

Coronary intervention related complications which reduce coronary blood flow can be associated with periprocedural myocardial infarction {Type 4a as per the Fourth Universal Definition of Myocardial Infarction (2018)}. Important causes of coronary procedure related myocardial infarction are:

1. Coronary dissection
2. Occlusion of a major epicardial coronary artery or side branch occlusion
3. Disruption of collateral flow
4. Slow flow or no-reflow
5. Distal embolization

For the diagnosis of periprocedural myocardial infarction the cut off level of troponin elevation of at least 5 times the 99th percentile of upper reference limit is considered. In addition, either new ischemic ECG changes, new pathological Q waves, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality corresponding to a coronary territory or angiographic findings as mentioned above are needed for diagnosis of periprocedural myocardial infarction. Pathological demonstration of thrombus in the culprit artery or macroscopic large area of myocardial necrosis also qualifies for a diagnosis of type 4a myocardial infarction.

Reference

1. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018 Oct 30;72(18):2231-2264.