<p id="hl0000054" class="ng-scope"><b>Double whammy:<span> </span><i>noun<span> </span></i></b>[C usually singular]</p> <p id="hl0000057" class="ng-scope">“<span> </span><i>a situation when two unpleasant things happen at almost the same time</i><span> </span>”</p> <p id="hl0000059" class="ng-scope">Cambridge Dictionary</p> <p id="hl0000060" class="ng-scope">After the introduction of more sensitive cardiac biomarkers, the European Society of Cardiology and the American College of Cardiology collaborated on a new Expert Consensus document on the Fourth Universal Definition of Myocardial Infarction using a biochemical and clinical approach, particularly for those patients undergoing coronary and cardiac procedures<span> </span><button class="j-inline-reference inline-reference u-els-color-linkblue" data-refid="bb0005" id="refInSitubb0005">[1]</button><span> </span>. According to this update, any elevation of cardiac biomarkers in the presence of ischemia is now labeled as a myocardial infarction (MI) and the presence of elevated cardiac biomarkers with no evidence of ischemia is defined as myocardial injury. Percutaneous coronary intervention (PCI) associated MI (type 4a MI), requires an elevation of cardiac troponin (cTn) levels >5 times the 99th percentile upper reference limit (URL) in patients with normal baseline values<span> </span><button class="j-inline-reference inline-reference u-els-color-linkblue" data-refid="bb0005" id="refInSitubb0005">[1]</button><span> </span>. However, a large proportion of patients have abnormal cTn values after PCI and whether it is a marker of adverse prognosis and long-term mortality has been (and continues to be) the subject of intense debate<span> </span><button class="j-inline-reference inline-reference u-els-color-linkblue" data-refid="bb0010" id="refInSitubb0010">[2]</button><span> </span>.</p>