A twist in our understanding of enzyme elevation after coronary intervention.

Central to our understanding of acute myocardial infarction (MI) is the tight relationship between myonecrosis and the presence of elevated serum levels of certain enzymes known to originate from within myocardial cells. Together with presence of either chest discomfort or typical electrocardiographic (ECG) changes, an elevation in cardiac enzymes confirms the diagnosis of acute MI. Recently, even more emphasis has been placed on the significance of the role of serum enzymes. One publication revising criteria for acute MI indicates that the isolated finding of enzyme elevation in the setting of a percutaneous coronary intervention (PCI) is sufficient for the diagnosis of acute MI (1). This change in definition has major implications when gauging the risk/ benefit ratio of PCI, especially in comparison with alternative treatment options.