Type 2 myocardial infarction in clinical practice

Baron, Tomasz; Hambræus, Kristina; Sundström, Johan; Erlinge, David; Jernberg, Tomas; Lindahl, Bertil

doi:10.1136/heartjnl-2014-306093

Cited by 178 publications

(184 citation statements)

References 12 publications

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“…The prevalence of type 2 MI is between 3% and 26% in observational cohorts (3,5,(12)(13)(14) and in clinical trials (15,16). In our study, about 5% of MIs were deemed to be type 2 by the CEC.…”

Section: Discussionmentioning

confidence: 89%

“…Uncertainties in the attribution of the correct type of MI are also reflected by the wide variation in the reported relative occurrence of type 2 MI (3-26% of all MIs) in several studies (2)(3)(4)(5)(6)(7)(8). Moreover, the availability of high-sensitivity troponin assays will likely increase the number of patients who have elevated biomarkers in a variety of clinical conditions (9).…”

Section: Introductionmentioning

confidence: 99%

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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

Guimarães

Leonardi

Huang

et al. 2018

American Heart Journal

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

Leonardi

Huang

et al. 2018

American Heart Journal

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“…All observational studies through 30 June 2016 that compared presenting symptoms, baseline characteristics, interventions, and mortality outcomes between type 1 and type 2 MI were identified by conducting a search in the databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE using the search terms "Type-1 myocardial infarction", "versus", "Type-2 myocardial infarction", and "Demand Ischemia" (5,8,9,(11)(12)(13)(14)(15)(16). We also searched the major cardiovascular conference proceedings, bibliographies of original trials, meta-analyses and review articles.…”

Section: Eligibility Criteria and Data Extractionmentioning

confidence: 99%

Type 2 versus type 1 myocardial infarction: a comparison of clinical characteristics and outcomes with a meta-analysis of observational studies

Gupta¹,

Vaidya²,

Arora³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Type 2 myocardial infarction (MI) is an imbalance between myocardial oxygen demand and supply, leading to myocardial ischemia. It is not due to plaque rupture, and is usually caused by a condition other than coronary artery disease (CAD). However, limited data are available comparing the prevalence of traditional coronary risk factors and mortality between type 1 and type 2 MI. We hypothesize that type 2 MI carries a higher mortality than type 1. Methods:We searched the databases of PubMed, EMBASE, CENTRAL, and MEDLINE for studies comparing type 1 MI with type 2 MI. The baseline variables were compared in each cohort. Summary risk ratios and 95% confidence intervals were calculated using the random effects model to compare mortality between the two groups. Results:The included studies yielded 25,872 patients of whom 2,683 (10%) had type 2 MI. Compared to the type 1 cohort, the type 2 cohort had significantly higher inpatient (15% vs. 4.7%, P<0.00001), 30-day (17.6% vs. 5.3%, P<0.00001) and 1-yr mortality (27% vs. 13%, P<0.00001), as well as higher 30-day major adverse cardiovascular events (20% vs. 9%, P<0.0001). Operative stress (20%) was the most common trigger of type 2 MI, followed by sepsis (19%), arrhythmia (18.63%), heart failure (15%), and anemia (12%).Conclusions: Type 2 MI is a common entity and is more common in females, older age groups, and in patients with multiple comorbidities: it also tends to result in higher mortality.

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“…In support of this concept, there is emerging evidence that patients with demand ischemia may have mortality rates equivalent to or perhaps exceeding patients with true ACS across a variety of clinical circumstances 12, 13, 14, 15. This may be driven by underlying medical comorbidities,16 or perhaps misclassification of a subset of these patients as type 2 MI, when in fact they had type 1 MI 17.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

Reed

Horr

Young

et al. 2017

JAHA

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BackgroundThe time‐sensitive hazard of perioperative cardiac troponin T (cTnT) elevation and whether long‐term mortality differs by mechanism of myocardial injury are poorly understood.Methods and ResultsIn this observational study of 12 882 patients who underwent noncardiac vascular surgery, patients were assessed for cTnT sampling within 96 hours postoperatively. Mortality out to 5‐years was stratified by cTnT level and mechanism of myocardial injury. During a median follow‐up of 26.9 months, there were 2149 (16.7%) deaths. By multivariable Cox proportional hazards analysis, there was a graded increase in mortality with any detectable cTnT compared to <0.01 ng/mL; cTnT 0.01 to 0.029 ng/mL hazard ratio (HR) 1.54 (95% CI 1.18–2.00, P=0.002), 0.03 to 0.099 ng/mL HR 1.86 (95% CI 1.49–2.31, P<0.001), 0.10 to 0.399 ng/mL HR 1.83 (95% CI 1.46–2.31, P<0.001), ≥0.40 ng/mL HR 2.62 (95% CI 2.06–3.32, P<0.001). Mortality for each mechanism of injury was greater than for patients with normal cTnT; baseline cTnT elevation HR 1.71 (95% CI 1.31–2.24; P<0.001), Type 2 myocardial infarction HR 1.88 (95% CI 1.57–2.24; P<0.001), Type 1 MI HR 2.56 (95% CI 2.56, 1.82–3.60; P<0.001). On Kaplan–Meier analysis, long‐term survival did not differ between mechanisms. The hazard of mortality was greatest within the first 10 months postsurgery. Consistent results were obtained in confirmatory propensity‐score matched analyses.ConclusionsAny detectable cTnT ≥0.01 ng/mL is associated with increased long‐term mortality after vascular surgery. This risk is greatest within the first 10 months postoperatively. While short‐term mortality is greatest with Type 1 myocardial infarction, long‐term mortality appears independent of the mechanism of injury.

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Type 2 myocardial infarction in clinical practice

Cited by 178 publications

References 12 publications

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

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

Type 2 versus type 1 myocardial infarction: a comparison of clinical characteristics and outcomes with a meta-analysis of observational studies

Associations Between Cardiac Troponin, Mechanism of Myocardial Injury, and Long‐Term Mortality After Noncardiac Vascular Surgery

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