New ischaemic symptoms (e.g. chest pain or shortness of breath), or new ischaemic signs (e.g. ventricular arrhythmias, new or worsening heart failure, new ST-segment changes, haemodynamic instability, new pathological Q-waves in at least two contiguous leads, imaging evidence of new loss of viable myocardium or new wall motion abnormality) AND

 Elevated cardiac biomarkers (preferable CK-MB) within 72 h after the index procedure, consisting of at least one sample post-procedure with a peak value exceeding 15× as the upper reference limit for troponin or 5× for CK-MB.^a If cardiac biomarkers are increased at baseline (>99th percentile), a further increase in at least 50% post-procedure is required AND the peak value must exceed the previously stated limit

 Detection of rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile URL, together with the evidence of myocardial ischaemia with at least one of the following:

 Symptoms of ischaemia

 ECG changes indicative of new ischaemia [new ST-T changes or new left bundle branch block (LBBB)]

 New pathological Q-waves in at least two contiguous leads

 Imaging evidence of a new loss of viable myocardium or new wall motion abnormality

 Sudden, unexpected cardiac death, involving cardiac arrest, often with symptoms suggestive of myocardial ischaemia, and accompanied by presumably new ST elevation, or new LBBB, and/or evidence of fresh thrombus by coronary angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood.

 Pathological findings of an acute myocardial infarction