European Association of Cardio-Thoracic Surgery (EACTS) expert consensus statement on perioperative myocardial infarction after cardiac surgery

Cardiac surgery may lead to myocardial damage and release of cardiac biomarkers through various mechanisms such as cardiac manipulation, systemic inflammation, myocardial hypoxia, cardioplegic arrest and ischaemia caused by coronary or graft occlusion. Definingperioperative myocardial infarction (PMI) after cardiac surgery presents challenges, and the association between the current PMI definitions and postoperative outcomes remains uncertain. To address these challenges, the European Association of Cardio-Thoracic Surgery(EACTS) facilitated collaboration among a multidisciplinary group to evaluate the existing evidence on the mechanisms, diagnosis andprognostic implications of PMI after cardiac surgery. The review found that the postoperative troponin value thresholds associated withan increased risk of mortality are markedly higher than those proposed by all the current definitions of PMI. Additionally, it was foundthat large postoperative increases in cardiac biomarkers are prognostically relevant even in absence of additional supportive signs ofischaemia. A new algorithm for PMI detection after cardiac surgery was also proposed, and a consensus was reached within the groupthat establishing a prognostically relevant definition of PMI is critically needed in the cardiovascular field and that PMI should beincluded in the primary composite outcome of coronary intervention trials.