Mortality Rate in Type 2 Myocardial Infarction: Observations from an Unselected Hospital Cohort

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• 作者：Lotte Saaby ; MD^a ; Tina Svenstrup Poulsen ; MD ; PhD^a ; Axel Cosmus Pyndt Diederichsen ; MD ; PhD^a ; Susanne Hosbond ; MD^a ; Torben Bjerregaard Larsen ; MD ; PhD^b ; Henrik Schmidt ; MD ; DMSc^c ; Oke Gerke ; MSc ; PhD^d ; Jesper Hallas ; MD ; DMSc^e ; Kristian Thygesen ; MD ; DMSc^f ; Hans Mickley ; MD ; DMSc^a ; ^{Hans.mickley@rsyd.dk" class="auth_mail}
• 关键词：Acute myocardial infarction ; Mortality ; Prognosis ; Type 2 myocardial infarction ; Universal definition
• 刊名：The American Journal of Medicine
• 出版年：April, 2014
• 年：2014
• 卷：127
• 期：4
• 页码：295-302
• 全文大小：506 K

文摘

Background

The classification of myocardial infarction into 5 types was introduced in 2007. The prognostic impact of this universal definition, with particular focus on type 2 myocardial infarction, has not been studied prospectively in unselected hospital patients.

Methods

During a 1-year period, all hospitalized patients having cardiac troponin I measured were considered. The diagnosis of a myocardial infarction was according to the universal definition, and specified criteria were used in the classification of type 2 myocardial infarction. Follow-up was at least 1聽year, with mortality as the end point.

Results

A total of 3762 consecutive patients were studied, of whom 488 (13%) had a myocardial infarction. In 119 patients a type 2 myocardial infarction was diagnosed. After a median of 2.1 years (interquartile range, 1.6-2.5 years), 150 patients had died, with a mortality rate of 49% (58/119) in those with type 2 myocardial infarction and 26% (92/360) in those with type 1 myocardial infarction (P < .0001). In a multivariable Cox regression analysis the following variables were independently associated with mortality: current or prior smoker, high age, prior myocardial infarction, type 2 myocardial infarction, hypercholesterolemia, high p-creatinine, and diabetes mellitus. The multivariable-adjusted hazard ratio for type 2 myocardial infarction was 2.0 (95% confidence interval, 1.3-3.0). With shock as the only exception, mortality was independent of the triggering conditions leading to type 2 myocardial infarction.

Conclusions

Mortality in patients with type 2 myocardial infarction is high, reaching approximately 50% after 2 years. Further descriptive and survival studies are needed to improve the scientific evidence on which treatment of type 2 myocardial infarction is based.