Clinical features and outcomes of patients with type 2 myocardial infarction: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial

Guimarães, Patrícia O.; Leonardi, Sergio; Huang, Zhen; Wallentin, Lars; Werf, Frans Van de; Aylward, Philip E.; Held, Claes; Harrington, Robert A.; Moliterno, David J.; Armstrong, Paul W.; White, Harvey D.; Alexander, Karen P.; Lópes, Renato D.; Mahaffey, Kenneth W.; Tricoci, Pierluigi

doi:10.1016/j.ahj.2017.10.007

Cited by 11 publications

(15 citation statements)

References 25 publications

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“…This review systematically evaluated T2MI triggers and listed the leading cause and other common causes, especially in single‐trigger cases; our findings also shed light on the underlying etiologies, which may help improve the decision regarding treatment options. In the TRACER trial, the most frequent potential provoking factor for T2MI was tachyarrhythmia (38.2%), which is consistent with our findings . A meta‐analysis also demonstrated that the most common associated arrhythmia was tachyarrhythmia, especially atrial fibrillation, in patients with T2MI .…”

Section: Discussionsupporting

confidence: 90%

“…In the TRACER trial, the most frequent potential provoking factor for T2MI was tachyarrhythmia (38.2%), which is consistent with our findings. 30 A meta-analysis also demonstrated that the most common associated arrhythmia was tachyarrhythmia, especially atrial fibrillation, in patients with T2MI. 25 Most patients with T2MI died from noncardiovascular causes during long-term follow-up.…”

Section: Discussionmentioning

confidence: 98%

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A systematic review on the triggers and clinical features of type 2 myocardial infarction

Wang

Zhao

Zhong

et al. 2019

Clinical Cardiology

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Little is known about the correlation between triggering factors, clinical characteristics, diagnosis, and prognosis of patients with type 2 myocardial infarction (T2MI). The triggers and features of T2MI are linked to its diagnosis and prognosis. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. A structured search of three databases (PubMed, Embase, and Medline) was undertaken to identify peer‐reviewed articles related to the triggers and clinical features of T2MI published between January 2012 and August 2018. Seven retrospective cohort studies and seven prospective cohort studies involving 3867 patients with T2MI were included. All selected studies were rated as being of high or acceptable quality. Nine studies revealed that the leading trigger of T2MI was arrhythmia, especially tachyarrhythmia. Six studies revealed that the proportion of single‐trigger T2MIs was higher than that of multiple triggers and two studies showed that two‐trigger cases formed the majority of multiple trigger cases. All included studies found that a greater prevalence of T2MI in the older population. Thirteen studies revealed that the patients with T2MI often had a previous relevant medical history. The leading trigger of T2MI is arrhythmia, especially tachyarrhythmia, and the majority of cases arise from a single trigger. Two‐trigger is the most common form of multiple‐trigger T2MI, which often occurs in older patients with cardiovascular risk factors or comorbidities. Non‐cardiovascular causes may be the triggering factors and are strongly associated with the diagnosis, treatment, and prognosis of T2MI.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 98%

A systematic review on the triggers and clinical features of type 2 myocardial infarction

Wang

Zhao

Zhong

et al. 2019

Clinical Cardiology

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“…A total of 40 studies were included for analysis13–52 and their characteristics are summarised in online supplemental table S3. They comprised a total of 127 620 participants of whom 98 930 participants (77.5%) were classified as T1MI and 13 803 (10.8%) as T2MI.…”

Section: Resultsmentioning

confidence: 99%

“…The 2007 definition1 was used in 7 (17.5%) studies,15 16 27 29 43 44 52 the 2012 definition2 in 25 (62.5%) studies,13 17 19–21 23–26 30–35 37 39 40 42 45–48 50 51 and the 2018 definition3 in 8 (20%) studies 14 18 22 28 36 38 41 49. Of the 40 studies, 17 (42.5%) were prospective15 16 18 19 22 29 33 34 36 37 43–45 47 48 50 51and 23 (57.5%) were retrospective 13 14 17 20 21 23–28 30–32 35 38–42 46 49 52…”

Section: Resultsmentioning

confidence: 99%

“…Of the 40 studies, 31 (77.5%) were assessed as good quality,13 15–19 22 23 27–35 37–46 48 50–52 6 (15%) as fair quality,14 21 24–26 49and 3 (7.5%) as poor quality,20 36 47 as summarised in online supplemental table S4. Selection bias resulting in unrepresentative cohorts such as admission criteria to coronary care units or entry criteria into MI registries favouring T1MI,14 20 24–26 36 47 49 absence of independent adjudication of MI type as T1MI or T2MI,36 38 47 non-comparability of T1MI and T2MI cohorts,20 24 25 47 poorly specified outcome measures36 38 47 and short follow-up period resulting in few events14 20 24 36 comprised most forms of bias.…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis

2022

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ImportanceDistinguishing type 2 (T2MI) from type 1 myocardial infarction (T1MI) in clinical practice can be difficult, and the management and prognosis for T2MI remain uncertain.ObjectiveTo compare precipitating factors, risk factors, investigations, management and outcomes for T2MI and T1MI.Data sourcesMedline and Embase databases as well as reference list of recent articles were searched January 2009 to December 2020 for term ‘type 2 myocardial infarction’.Study selectionStudies were included if they used a universal definition of MI and reported quantitative data on at least one variable of interest.Data extraction and synthesisData were pooled using random-effect meta-analysis. Risk of bias was assessed using Newcastle-Ottawa quality assessment tool. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. All review stages were conducted by two reviewers.Main outcomes and measuresRisk factors, presenting symptoms, cardiac investigations such as troponin and angiogram, management and outcomes such as mortality.Results40 cohort studies comprising 98 930 patients with T1MI and 13 803 patients with T2MI were included. Compared with T1MI, patients with T2MI were: more likely to have pre-existing chronic kidney disease (OR 1.87; 95% CI 1.53 to 2.28) and chronic heart failure (OR 2.35; 95% CI 1.82 to 3.03), less likely to present with typical cardiac symptoms of chest pain (OR 0.19; 95% CI 0.13 to 0.26) and more likely to present with dyspnoea (OR 2.64; 95% CI 1.86 to 3.74); more likely to demonstrate non-specific ST-T wave changes on ECG (OR 2.62; 95% CI 1.81 to 3.79) and less likely to show ST elevation (OR 0.22; 95% CI 0.17 to 0.28); less likely to undergo coronary angiography (OR 0.09; 95% CI 0.06 to 0.12) and percutaneous coronary intervention (OR 0.06; 95% CI 0.04 to 0.10) or receive cardioprotective medications, such as statins (OR 0.25; 95% CI 0.16 to 0.38) and beta-blockers (OR 0.45; 95% CI 0.33 to 0.63). T2MI had greater risk of all cause 1-year mortality (OR 3.11; 95% CI 1.91 to 5.08), with no differences in short-term mortality (OR 1.34; 95% CI 0.63 to 2.85).Conclusion and relevanceThis review has identified clinical, management and survival differences between T2MI and T1MI with greater precision and scope than previously reported. Differential use of coronary revascularisation and cardioprotective medications highlight ongoing uncertainty of their utility in T2MI compared with T1MI.

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Incidence, Characteristics, and Outcomes of Myocardial Infarction in Patients With Peripheral Artery Disease

et al. 2019

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IMPORTANCE Patients with peripheral artery disease (PAD) are at high risk for myocardial infarction (MI).OBJECTIVE To characterize the incidence and types of MI in a PAD population, identify factors associated with MI, and determine the association of MI with cardiovascular mortality and acute limb ischemia. DESIGN, SETTING, AND PARTICIPANTSThe Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease (EUCLID) was a double-blind randomized clinical trial conducted at 811 sites in 28 countries that randomized 13 885 patients with symptomatic PAD to monotherapy with ticagrelor or clopidogrel. Participants had an ankle-brachial index (ABI) of 0.80 or less or previous lower extremity revascularization. Median follow-up was 30 months. For these analyses, patients were evaluated for MI occurrence during follow-up irrespective of treatment. Data were analyzed from June 2017 to September 2018. MAIN OUTCOMES AND MEASURESAn adjudication clinical events committee classified MI as type 1 (spontaneous), type 2 (secondary), type 3 (sudden cardiac death), type 4a (less than 48 hours after percutaneous coronary intervention), type 4b (definite stent thrombosis), or type 5 (less than 72 hours after coronary artery bypass graft). A multivariate regression model was developed by stepwise selection to identify factors associated with MI, and a time-dependent multivariate Cox regression analysis was performed to determine the association of MI with cardiovascular death and acute limb ischemia requiring hospitalization. RESULTSOf the 13 885 patients included in this analysis, 9997 (72.0%) were male, and the median (interquartile range) age was 66 (60-73) years. Myocardial infarction occurred in 683 patients (4.9%; 2.4 events per 100 patient-years) during a median follow-up of 30 months. Patients experiencing MI were older (median [interquartile range] age, 69 [62-75] vs 66 [60-72] years), more likely to have diabetes (349 of 683 [51.1%] vs 4996 of 13 202 [37.8%]) or a previous lower extremity revascularization (466 of 683 [68.2%] vs 7409 of 13 202 [56.1%]), and had a lower ABI (if included by ABI) compared with censored patients. Of the 683 patients with MI during follow-up, the most common MI type was type 1 (405 [59.3%]), followed by type 2 (236 [34.6%]), type 4a (14 [2.0%]), type 3 (12 [1.8%]), type 4b (11 [1.6%]), and type 5 (5 [0.7%]). Postrandomization MI was independently associated with cardiovascular death (adjusted hazard ratio, 9.0; 95% CI, 7.3-11.2; P < .001) and acute limb ischemia requiring hospitalization (adjusted hazard ratio, 2.5; 95% CI, 1.3-5.0; P = .008). CONCLUSIONS AND RELEVANCEApproximately 5% of patients with symptomatic PAD had an MI during a median follow-up of 30 months. Type 1 MI (spontaneous) was the most common MI type; however, one-third of MIs were type 2 MI (secondary). More research is needed to identify therapies to reduce the risk of MI in patients with PAD and to improve management of type 2 MI.

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Clinical features and outcomes of patients with type 2 myocardial infarction: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial

Cited by 11 publications

References 25 publications

A systematic review on the triggers and clinical features of type 2 myocardial infarction

A systematic review on the triggers and clinical features of type 2 myocardial infarction

Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis

Incidence, Characteristics, and Outcomes of Myocardial Infarction in Patients With Peripheral Artery Disease

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