Type-II Myocardial Infarction – Patient Characteristics, Management and Outcomes

Abstract

BackgroundType-II MI is defined as myocardial infarction (MI) secondary to ischemia due to either increased oxygen demand or decreased supply. This categorization has been used for the last five years, yet, little is known about patient characteristics and clinical outcomes. In the current work we assessed the epidemiology, causes, management and outcomes of type II MI patients.MethodsA comparative analysis was performed between patients with type-I and type-II MI who participated in two prospective national Acute Coronary Syndrome Israeli Surveys (ACSIS) performed in 2008 and 2010.ResultsThe surveys included 2818 patients with acute MI of whom 127 (4.5%) had type-II MI. The main causes of type-II MI were anemia (31%), sepsis (24%), and arrhythmia (17%). Patients with type-II MI tended to be older (75.6±12 vs. 63.8±13, p<0.0001), female majority (43.3% vs. 22.3%, p<0.0001), had more frequently impaired functional level (45.7% vs. 17%, p<0.0001) and a higher GRACE risk score (150±32 vs. 110±35, p<0.0001). Patients with type-II MI were significantly less often referred for coronary interventions (36% vs. 89%, p<0.0001) and less frequently prescribed guideline-directed medical therapy. Mortality rates were substantially higher among patients with type-II MI both at thirty-day (13.6% vs. 4.9%, p<0.0001) and at one-year (23.9% vs. 8.6%, p<0.0001) follow-ups.ConclusionsPatients with type-II compared to type-I MI have distinct demographics, increased prevalence of multiple comorbidities, a high-risk cardiovascular profile and an overall worse outcome. The complex medical condition of this cohort imposes a great therapeutic challenge and specific guidelines with recommended medical treatment and invasive strategies are warranted.

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

“…In our study, we observed that more than half of the patients with type 2 MIs presented with chest pain and symptoms thought to be typical of ischemia, which is in accordance with previous studies (2,4,5). It has been previously observed that atypical presentation is much more common among type 2 MIs than type 1 MIs (23).…”

“…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).…”

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

“…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.…”

Antro Tipo Miokardo Infarktas

“…ir kt. [10] atlikto tyrimo duomenimis, 50 % II tipo MI įvyksta dėl anemijos ir sepsio. Pacientai su II tipo MI dažnai turi didelę širdies ir kraujagyslių ligų riziką, todėl intervencinis gydymas gali būti taikomas tam tikrai daliai pacientų.…”