Characteristics and Outcomes of Type 2 Myocardial Infarction
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Characteristics and Outcomes of Type 2 Myocardial Infarction. / Coscia, Tania; Nestelberger, Thomas; Boeddinghaus, Jasper; Lopez-Ayala, Pedro; Koechlin, Luca; Miró, Òscar; Keller, Dagmar I; Strebel, Ivo; Yufera Sanchez, Ana; Okamura, Bernhard; Wussler, Desiree; Shrestha, Samyut; Hausknecht, Katharina; Martín-Sánchez, F Javier; Christ, Michael; Kawecki, Damian; Twerenbold, Raphael; Wildi, Karin; Rubini Gimenez, Maria; Mueller, Christian; APACE Investigators.
in: JAMA CARDIOL, Jahrgang 7, Nr. 4, 01.04.2022, S. 427-434.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Characteristics and Outcomes of Type 2 Myocardial Infarction
AU - Coscia, Tania
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Lopez-Ayala, Pedro
AU - Koechlin, Luca
AU - Miró, Òscar
AU - Keller, Dagmar I
AU - Strebel, Ivo
AU - Yufera Sanchez, Ana
AU - Okamura, Bernhard
AU - Wussler, Desiree
AU - Shrestha, Samyut
AU - Hausknecht, Katharina
AU - Martín-Sánchez, F Javier
AU - Christ, Michael
AU - Kawecki, Damian
AU - Twerenbold, Raphael
AU - Wildi, Karin
AU - Rubini Gimenez, Maria
AU - Mueller, Christian
AU - APACE Investigators
PY - 2022/4/1
Y1 - 2022/4/1
N2 - IMPORTANCE: In contrast to type 1 myocardial infarction (T1MI) caused by atherothrombosis, characteristics and outcomes of type 2 myocardial infarction (T2MI) caused by supply-demand mismatch are incompletely understood.OBJECTIVE: To explore the characteristics and outcomes of patients with T2MI compared with those with T1MI.DESIGN, SETTING, AND PARTICIPANTS: In a prospective, international, multicenter cohort study including 12 emergency departments (EDs) in 5 European countries, unselected patients presenting with acute chest discomfort were enrolled from April 2006 to April 2018. Follow-up was done by telephone or in written form 3, 12, and 24 months after hospital discharge. Data were analyzed from April 2006 to April 2020.INTERVENTIONS: The final diagnoses of T2MI and T1MI were centrally adjudicated according to the Fourth Universal Definition of Myocardial Infarction by 2 independent cardiologists, including the pathophysiological trigger of T2MI.MAIN OUTCOMES AND MEASURES: Patient characteristics and outcomes, including 2-year all-cause and cardiovascular mortality and future T2MI and T1MI events.RESULTS: Of 6253 included patients, 2078 (33.2%) were women, and the median (IQR) age was 61 (48-74) years. Among 6253 patients with acute chest discomfort, the final adjudicated diagnosis was T2MI in 251 patients (4.0%), with tachyarrhythmia and hypertension responsible for two-thirds of cases, and T1MI in 1027 patients (16.4%). All-cause and cardiovascular mortality were comparable at 2 years (T2MI: adjusted hazard ratio, 1.0; 95% CI, 0.7-1.5; T1MI: adjusted hazard ratio, 0.7; 95% CI, 0.4-1.1). Patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI was more likely among patients with index T2MI compared with patients with index T1MI (hazard ratio, 3.2; 95% CI, 1.4-7.5). Similarly, future T1MI was more likely to occur among patients with index T1MI (hazard ratio, 3.0; 95% CI, 1.2-7.4).CONCLUSIONS AND RELEVANCE: Among patients with T2MI, tachyarrhythmia and hypertension were responsible for more than two-thirds of T2MI cases. While T2MI and T1MI had comparable all-cause and cardiovascular mortality at 2 years, patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI occurred 3-fold more frequently among patients with T2MI vs T1MI as the index event. Improved understanding of the specifics of patients with T2MI should help improve management strategies.
AB - IMPORTANCE: In contrast to type 1 myocardial infarction (T1MI) caused by atherothrombosis, characteristics and outcomes of type 2 myocardial infarction (T2MI) caused by supply-demand mismatch are incompletely understood.OBJECTIVE: To explore the characteristics and outcomes of patients with T2MI compared with those with T1MI.DESIGN, SETTING, AND PARTICIPANTS: In a prospective, international, multicenter cohort study including 12 emergency departments (EDs) in 5 European countries, unselected patients presenting with acute chest discomfort were enrolled from April 2006 to April 2018. Follow-up was done by telephone or in written form 3, 12, and 24 months after hospital discharge. Data were analyzed from April 2006 to April 2020.INTERVENTIONS: The final diagnoses of T2MI and T1MI were centrally adjudicated according to the Fourth Universal Definition of Myocardial Infarction by 2 independent cardiologists, including the pathophysiological trigger of T2MI.MAIN OUTCOMES AND MEASURES: Patient characteristics and outcomes, including 2-year all-cause and cardiovascular mortality and future T2MI and T1MI events.RESULTS: Of 6253 included patients, 2078 (33.2%) were women, and the median (IQR) age was 61 (48-74) years. Among 6253 patients with acute chest discomfort, the final adjudicated diagnosis was T2MI in 251 patients (4.0%), with tachyarrhythmia and hypertension responsible for two-thirds of cases, and T1MI in 1027 patients (16.4%). All-cause and cardiovascular mortality were comparable at 2 years (T2MI: adjusted hazard ratio, 1.0; 95% CI, 0.7-1.5; T1MI: adjusted hazard ratio, 0.7; 95% CI, 0.4-1.1). Patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI was more likely among patients with index T2MI compared with patients with index T1MI (hazard ratio, 3.2; 95% CI, 1.4-7.5). Similarly, future T1MI was more likely to occur among patients with index T1MI (hazard ratio, 3.0; 95% CI, 1.2-7.4).CONCLUSIONS AND RELEVANCE: Among patients with T2MI, tachyarrhythmia and hypertension were responsible for more than two-thirds of T2MI cases. While T2MI and T1MI had comparable all-cause and cardiovascular mortality at 2 years, patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI occurred 3-fold more frequently among patients with T2MI vs T1MI as the index event. Improved understanding of the specifics of patients with T2MI should help improve management strategies.
KW - Humans
KW - Myocardial Infarction/therapy
KW - Risk Factors
U2 - 10.1001/jamacardio.2022.0043
DO - 10.1001/jamacardio.2022.0043
M3 - SCORING: Journal article
C2 - 35262640
VL - 7
SP - 427
EP - 434
JO - JAMA CARDIOL
JF - JAMA CARDIOL
SN - 2380-6583
IS - 4
ER -