Implications of Misclassification of Type 2 Myocardial Infarction on Clinical Outcomes

Hawatmeh, Amer; Thawabi, Mohammad; Aggarwal, Rashmi; Abirami, C; Vavilin, Ilan; Wasty, Najam; Visveswaran, Gautam; Cohen, Marc

doi:10.1016/j.carrev.2019.04.009

Cited by 20 publications

(26 citation statements)

References 18 publications

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“…Prognosis, in terms of short‐ and longer‐term mortality risks following NSTEMI, has improved in recent years, with fewer deaths after 30 days and more of the deaths that do occur being attributed to non‐CV causes . However, the risk of in‐hospital and post‐discharge mortality following NSTEMI is higher in patients with type 2 NSTEMI than in those with type 1 NSTEMI . This is not surprising and can be explained by the sicker and older age demographic of patients with type 2 NSTEMI compared with those with type 1 NSTEMI …”

Section: Discussionmentioning

confidence: 99%

“…As a result, current NSTEMI guidelines may be challenging—or in some cases inappropriate—to apply in patients who are experiencing a type 2 NSTEMI, and no formal guidelines for type 2 NSTEMI are available . Studies have found that compared with patients with type 1 NSTEMI, patients with type 2 NSTEMI were less likely to undergo catheterization and revascularization procedures or receive recommended secondary prevention medications at discharge, and they had higher mortality rates . There is therefore a need for evidence‐based diagnosis and management guidelines for NSTEMI that acknowledge the complexities of type 2 MI .…”

Section: Epidemiologymentioning

confidence: 99%

“…24 In addition to differences in prevalence between clinical settings, type 2 MI is often incorrectly classified as type 1 MI because it was not recognized as a separate condition by the International Classification of Diseases (ICD) coding system until October 2017. 19,25,26 An analysis of patients diagnosed with type 1 NSTEMI according to ICD-9 and ICD-10 codes between January 2015 and September 2017 found that 281 of 945 (29.7%) had type 2 MI and therefore required a different management strategy from those with type 1 MI. 26 Forty-five percent of patients diagnosed with a type 2 MI were reported to have no significant CAD, compared with only 12% of patients with type 1 MI.…”

Section: Prevalence Of Type 1 and Type 2 MI In Nstemimentioning

confidence: 99%

“…19,25,26 An analysis of patients diagnosed with type 1 NSTEMI according to ICD-9 and ICD-10 codes between January 2015 and September 2017 found that 281 of 945 (29.7%) had type 2 MI and therefore required a different management strategy from those with type 1 MI. 26 Forty-five percent of patients diagnosed with a type 2 MI were reported to have no significant CAD, compared with only 12% of patients with type 1 MI. 18 Underlying conditions that may predispose individuals to oxygen supply-demand imbalances, and thus type 2 MI, include hypotension, sepsis, anemia, tachyarrhythmia, respiratory failure, and hypertension.…”

Section: Prevalence Of Type 1 and Type 2 MI In Nstemimentioning

confidence: 99%

“…ASA, aspirin; CABG, coronary artery bypass graft; cath, cardiac catheterization; d, days; DAPT, dual antiplatelet therapy; GPI, glycoprotein IIb/IIIa inhibitor; h, hours; LOE, level of evidence; mo, months; NSTEMI, non-ST-elevation myocardial infarction; PCI, percutaneous coronary intervention; pts, patients; UFH, unfractionated heparin with type 1 NSTEMI to undergo revascularization, 20 and its benefit in type 2 NSTEMI has yet to be established. 26 In addition to absence of intracoronary thrombosis, almost half of the patients with type 2 MI do not have significant underlying CAD. 5,18 Therefore, guideline recommendations for revascularization in patients with NSTEMI may be more relevant to type 1 MI.…”

Section: Revascularizationmentioning

confidence: 99%

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Defining and managing patients with non‐ST‐elevation myocardial infarction: Sorting through type 1 vs other types

Cohen

Visveswaran

2020

Clinical Cardiology

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Advances in cardiovascular (CV) imaging, redefined electrocardiogram criteria, and high‐sensitivity CV biomarker assays have enabled more differentiated etiological classification of myocardial infarction (MI). Type 1 MI has a different underlying pathophysiology than type 2 through type 5 MI; type 1 MI is characterized primarily by intracoronary atherothrombosis and the other types by a variety of mechanisms, which can occur with or without an atherosclerotic component. In type 2 MI, there is evidence of myocardial oxygen supply‐demand imbalance unrelated to acute coronary atherothrombosis. Types 1 and 2 MI are spontaneous events, while type 4 and type 5 are procedure‐related; type 3 MI is identified only after death. Most type 1 and type 2 MI present as non‐ST‐elevation MI (NSTEMI), although both types can also present as ST‐elevation MI. Because of their different underlying etiologies, type 1 and type 2 NSTEMI have different presentation and prognosis and should be managed differently. In this article, we discuss the epidemiology, prognosis, and management of NSTEMI occurring in the setting of underlying type 1 or type 2 pathophysiology. Most NSTEMI (65%–90%) are type 1 MI. Patients with type 2 MI have multiple comorbidities and causes of in‐hospital mortality among these patients are not always CV‐related. It is important to distinguish between type 1 and type 2 NSTEMI early in the clinical course to allow for the use of the most appropriate treatments that will provide the greatest benefit for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%