Concordance and Prognostic Relevance of Angiographic and Clinical Definitions of Myocardial Infarction Type

Abstract

Background: Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis. Methods: Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed. Results: Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had “true” T1MI (atherothrombosis+ / triggers−); 174 (24.4%) were diagnosed with “true” T2MI (atherothrombosis− / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), P = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, P < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, P = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), P = 0.013 Conclusion: Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients.

Prognostic Significance of Echocardiographic Characteristics in Patients with Type 2 Myocardial Infarction: comparison with Type 1 Myocardial Infarction

“…However, in multivariate analysis, we did not find significant evidence of these factors increasing the risk of MACEs within 12 months. The role of these factors have been demonstrated in previous studies, including anemia [42,43], infections [43,44], and provoking conditions [45]. This lack of significance may be attributed to the relatively small size of the type 2 MI cases in our study, which could have hindered to detect these associations.…”

Characteristics and Prognosis of Type 2 Myocardial Infarction Through Worsening Renal Function and NT-proBNP in Older Adults with Pneumonia

“…In addition, medical indicators have association with all-cause mortality. 22 Assessing risk factors for 90-day adverse events play an important role in older type 2 MI individuals. The mortality after type 2 MI is significantly linked to the triggering factor for the mismatch of supply/demand.…”

“…[17][18][19][20][21] Medical triggers have association with all-cause death rate. 22 The mortality after type 2 MI differs depending on the pre-existing illness, and hypoxic respiratory failure is linked with the highest death rate. 23 Moreover, a significant increase in chronic kidney disease (CKD)-related mortality has been observed, and such a result is mainly due to the increase in ages 80 years or more.…”