Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction
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Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. / Nestelberger, Thomas; Boeddinghaus, Jasper; Badertscher, Patrick; Twerenbold, Raphael; Wildi, Karin; Breitenbücher, Dominik; Sabti, Zaid; Puelacher, Christian; Rubini Giménez, Maria; Kozhuharov, Nikola; Strebel, Ivo; Sazgary, Lorraine; Schneider, Deborah; Jann, Janina; du Fay de Lavallaz, Jeanne; Miró, Òscar; Martin-Sanchez, F Javier; Morawiec, Beata; Kawecki, Damian; Muzyk, Piotr; Keller, Dagmar I; Geigy, Nicolas; Osswald, Stefan; Reichlin, Tobias; Mueller, Christian; APACE Investigators.
In: J AM COLL CARDIOL, Vol. 70, No. 13, 26.09.2017, p. 1558-1568.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Badertscher, Patrick
AU - Twerenbold, Raphael
AU - Wildi, Karin
AU - Breitenbücher, Dominik
AU - Sabti, Zaid
AU - Puelacher, Christian
AU - Rubini Giménez, Maria
AU - Kozhuharov, Nikola
AU - Strebel, Ivo
AU - Sazgary, Lorraine
AU - Schneider, Deborah
AU - Jann, Janina
AU - du Fay de Lavallaz, Jeanne
AU - Miró, Òscar
AU - Martin-Sanchez, F Javier
AU - Morawiec, Beata
AU - Kawecki, Damian
AU - Muzyk, Piotr
AU - Keller, Dagmar I
AU - Geigy, Nicolas
AU - Osswald, Stefan
AU - Reichlin, Tobias
AU - Mueller, Christian
AU - APACE Investigators
N1 - Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2017/9/26
Y1 - 2017/9/26
N2 - BACKGROUND: Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice.OBJECTIVES: This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need.METHODS: The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI2007); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI2012).RESULTS: Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI2007 definition was 2.8% (n = 112). The application of the more liberal T2MI2012 definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI2012reclassified). Among T2MI2007, 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI2012reclassified patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI2012reclassified, which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI2007 (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI2012reclassified vs. T2MI2007 and T1MI: p = 0.03 and 0.01, respectively).CONCLUSIONS: T2MI2012reclassified has a substantially lower event-related mortality rate compared with T2MI2007 and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).
AB - BACKGROUND: Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice.OBJECTIVES: This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need.METHODS: The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI2007); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI2012).RESULTS: Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI2007 definition was 2.8% (n = 112). The application of the more liberal T2MI2012 definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI2012reclassified). Among T2MI2007, 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI2012reclassified patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI2012reclassified, which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI2007 (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI2012reclassified vs. T2MI2007 and T1MI: p = 0.03 and 0.01, respectively).CONCLUSIONS: T2MI2012reclassified has a substantially lower event-related mortality rate compared with T2MI2007 and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).
KW - Aged
KW - Aged, 80 and over
KW - Cohort Studies
KW - Coronary Artery Disease/complications
KW - Female
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Myocardial Infarction/diagnosis
KW - Prognosis
KW - Survival Rate
U2 - 10.1016/j.jacc.2017.07.774
DO - 10.1016/j.jacc.2017.07.774
M3 - SCORING: Journal article
C2 - 28935032
VL - 70
SP - 1558
EP - 1568
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 13
ER -
