Shifting the diagnosis of periprocedural myocardial infarction upstream.

Prevention of periprocedural myocardial infarction (MI) has been the target of substantial research effort.1,2 Even routine, elective, uncomplicated percutaneous coronary intervention (PCI) has been demonstrated to produce embolization.3 The greater the patient acuity is, such as with ST-segment elevation myocardial infarction, the larger is the degree of embolization and the more apparent the clinical consequences. Although the exact threshold of PCIrelated myonecrosis that is clinically relevant remains a matter of debate, few would challenge the central concept that myonecrosis is best avoided if possible.1,2