• Stefano De Servi and Antonio Landi.
• Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy. Electronic address: stefano.deservi01@gmail.com.
• Eur. J. Intern. Med. 2022 Feb 1; 96: 17-19.

AbstractThe prognostic role of procedural myocardial infarction (MI) is still controversial and matter of ongoing debate in the scientific community. A recent ESC Consensus Document confirmed the prognostic importance of type 4a MI and defined equally clinically relevant the major peri‑procedural myocardial injury, defined as the same cardiac Troponin cut-off threshold of type 4a MI without peri‑procedural angiographic complications, electrocardiographic or imaging evidence of new myocardial ischaemia. In the present manuscript we discuss available data supporting this paradigm shift and discuss some drawbacks which should be taken into account in interpreting the results. In light of recent mounting evidence, we challenge the prognostic relevance of major periprocedural myocardial injury, suggesting that type 4a MI should be the only definition for procedural MI to be used as an endpoint in clinical trials.Copyright © 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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