Long term outcomes in patients with type 2 myocardial infarction and myocardial injury

Chapman, A. R., Shah, A. S.V., Lee, K. K., Anand, A., Francis, O., Adamson, P., McAllister, D. A. , Strachan, F., Newby, D. E. and Mills, N. L. (2018) Long term outcomes in patients with type 2 myocardial infarction and myocardial injury. Circulation, 137(12), pp. 1236-1245. (doi: 10.1161/CIRCULATIONAHA.117.031806) (PMID:29150426) (PMCID:PMC5882250)

Abstract

Background—Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury. Methods—We identified consecutive patients (n=2,122) with elevated cardiac troponin I concentrations (≥0.05 μg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the Universal Definition of Myocardial Infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (MACE; non-fatal myocardial infarction or cardiovascular death) and non-cardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models. Results—The adjudicated index diagnosis was type 1 or type 2 myocardial infarction or myocardial injury in 1,171 (55.2%), 429 (20.2%) and 522 (24.6%) patients, respectively. At five years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were due to non-cardiovascular causes (HR 2.32, 95%CI 1.92-2.81, versus type 1 myocardial infarction). Despite this, the observed crude MACE rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for co-variates (HR 0.82, 95%CI 0.69-0.96). Coronary heart disease was an independent predictor of MACE in those with type 2 myocardial infarction or myocardial injury (HR 1.71, 95%CI 1.31-2.24). Conclusions—Despite an excess in non-cardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events to those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McAllister, Professor David and Newby, Professor David
• Authors: Chapman, A. R., Shah, A. S.V., Lee, K. K., Anand, A., Francis, O., Adamson, P., McAllister, D. A., Strachan, F., Newby, D. E., and Mills, N. L.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Circulation
• Publisher: American Heart Association
• ISSN: 0009-7322
• ISSN (Online): 1524-4539
• Published Online: 17 November 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Circulation 137(12): 1236-1245
• Publisher Policy: Reproduced under a Creative Commons License