Issues surrounding the routine assessment of cardiac biomarkers after PCI are complex, especially given that the definition of PCI-related MI has evolved over the years and most events are asymp- tomatic. The most recent consensus definition of MI consid- ers troponin elevations of 3 times the upper limit of normal as a PCI-related MI in patients with normal baseline levels; this is further classified as a type 4a MI.240 This definition is supported by studies with delayed-enhancement MRI con- firming that there is irreversible injury in the myocardium associated with biomarker elevations and that the size of this injury correlates with the degree of elevation.785 Furthermore, a meta-analysis of 15 observational studies found that tro- ponin elevations at any level were linked with worse in- hospital and long-term outcomes; elevations 3 times the upper limit of normal predicted even worse outcomes.242 Other observational data, however, have raised concerns about whether the relationship is causal.786,787 A recent study found creatinine kinase-MB to correlate better with MRI- detected MI than troponin level.788 Definitions of PCI-related MI are being reevaluated by the Task Force for the Redefi- nition of Myocardial Infarction. Although there may be value for individual operators and hospitals to routinely measure cardiac biomarkers to track rates of PCI-related MI, at present there are not compelling data to recommend this for all PCI procedures. 5.11. Vascular Closure Devices: Recommendations Class I 1. Patients considered for vascular closure devices should undergo a femoral angiogram to ensure their anatomic suitability for deployment. (Level of Evi- dence: C) Class IIa 1. The use of vascular closure devices is reasonable for the purposes of achieving faster hemostasis and earlier ambulation compared with the use of manual compression.257,789 791 (Level of Evidence: B) Class III: NO BENEFIT 1. 