Unwanted silent crosstalk: Troponinemia and surgeons

Table 1 Summary of the criteria for universal definition of myocardial infarction and myocardial injury

Variable	Definition
Myocardial injury	Detection of an elevated cTn value above the 99th percentile URL. The injury is considered acute if there is a rise and/or fall of cTn values
Type 1 MI	Detection of a rise and/or fall of cTn values with at least 1 value above the 99th percentile URL and with at least 1 of the below mentioned findings1. Identification of a coronary thrombus by angiography including intracoronary imaging or by autopsy
Type 2 MI	Detection of a rise and/or fall of cTn values with at least 1 value above the 99th percentile URL, requiring at least 1 of the below mentioned findings1. Identification of an imbalance between myocardial oxygen supply and demand unrelated to acute coronary atherothrombosis
Type 3 MI	Sudden cardiac death, with symptoms suggestive of myocardial ischemia accompanied by presumed new ischemic ECG changes or ventricular fibrillation but die before blood samples for biomarkers can be obtained, or before increases in cardiac biomarkers can be identified, or MI is detected by autopsy examination
Type 4 MI (cardiac procedural-related)	An increases of cTn values (> 99th percentile URL) in patients with normal baseline values (≤ 99th percentile URL) or a rise of cTn values > 20% of the baseline value when it is above the 99th percentile URL but it is stable or falling. Type 4 MI can be further classified into three subgroups
Type 5 MI (CABG-related MI)	An elevation of cTn values > 10 times the 99th percentile URL in patients with normal baseline cTn values In patients with elevated preprocedure cTn in whom cTn levels are stable (≤ 20% variation) or falling, the postprocedure cTn must rise by > 20%. The absolute postprocedural value still must be > 10 times the 99th percentile URL. In addition to one of these elements: Development of new pathological Q waves, angiographic documented new graft occlusion or new native coronary artery occlusion, imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology

¹Symptoms of acute myocardial ischemia; new ischemic electrocardiogram changes; development of pathological Q waves; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology.

Adopted from 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; 72: 2231-2264. cTn: Cardiac troponin; ECG: Electrocardiogram; MI: Myocardial injury; URL: Upper reference limit.