The improvement in cardiovascular outcomes over recent decades has been significant. Cardiovascular trials no longer rely solely on mortality but instead use composite endpoints that often include myocardial infarction (MI) due to its substantial impact on patient prognosis. The focus on periprocedural myocardial infarction (PPMI) has intensified because of its potential prognostic impact in patients undergoing revascularization procedures like percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) [ ]. While the definition and prognostic importance of spontaneous MI are widely agreed upon, PPMI's definition and prognostic significance are more debated [ , ]. PPMI definitions vary significantly, with three main ones being the Society for Cardiovascular Angiography and Interventions (SCAI) [ ], the Academic Research Consortium-2 (ARC-2) [ ], and the Fourth Universal Definition of Myocardial Infarction (4th UDMI) [ ]. Each definition employs different biomarker types and thresholds, with ARC-2 and UDMI also requiring additional criteria such as angiographic evidence of ischemia or electrocardiographic changes ( Fig. 1 ).