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Coscia T, Nestelberger T, Boeddinghaus J, Lopez-Ayala P, Koechlin L, Miró Ò, Keller DI, Strebel I, Yufera Sanchez A, Okamura B, Wussler D, Shrestha S, Hausknecht K, Martín-Sánchez FJ, Christ M, Kawecki D, Twerenbold R, Wildi K, Rubini Gimenez M, Mueller C. Characteristics and Outcomes of Type 2 Myocardial Infarction. JAMA Cardiol 2022; 7:427-434. [PMID: 35262640 PMCID: PMC8908230 DOI: 10.1001/jamacardio.2022.0043] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Question What are the characteristics and outcomes of type 2 myocardial infarction (T2MI) compared with type 1 myocardial infarction (T1MI) in patients presenting to the emergency department (ED) with acute chest discomfort? Findings In this cohort study 6253 patients, 251 patients (4.0%) and 1027 patients (16.4%) were diagnosed with T2MI and T1MI, respectively, and had comparable all-cause and cardiovascular mortality at 2 years. Tachyarrhythmia and hypertension were responsible for more than two-thirds of patients with T2MI and had lower mortality compared with patients with hypotension, hypoxemia, or anemia. Meaning Improved understanding of the specifics of patients with T2MI should help improve management strategies. Importance In contrast to type 1 myocardial infarction (T1MI) caused by atherothrombosis, characteristics and outcomes of type 2 myocardial infarction (T2MI) caused by supply-demand mismatch are incompletely understood. Objective To explore the characteristics and outcomes of patients with T2MI compared with those with T1MI. Design, Setting, and Participants In a prospective, international, multicenter cohort study including 12 emergency departments (EDs) in 5 European countries, unselected patients presenting with acute chest discomfort were enrolled from April 2006 to April 2018. Follow-up was done by telephone or in written form 3, 12, and 24 months after hospital discharge. Data were analyzed from April 2006 to April 2020. Interventions The final diagnoses of T2MI and T1MI were centrally adjudicated according to the Fourth Universal Definition of Myocardial Infarction by 2 independent cardiologists, including the pathophysiological trigger of T2MI. Main Outcomes and Measures Patient characteristics and outcomes, including 2-year all-cause and cardiovascular mortality and future T2MI and T1MI events. Results Of 6253 included patients, 2078 (33.2%) were women, and the median (IQR) age was 61 (48-74) years. Among 6253 patients with acute chest discomfort, the final adjudicated diagnosis was T2MI in 251 patients (4.0%), with tachyarrhythmia and hypertension responsible for two-thirds of cases, and T1MI in 1027 patients (16.4%). All-cause and cardiovascular mortality were comparable at 2 years (T2MI: adjusted hazard ratio, 1.0; 95% CI, 0.7-1.5; T1MI: adjusted hazard ratio, 0.7; 95% CI, 0.4-1.1). Patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI was more likely among patients with index T2MI compared with patients with index T1MI (hazard ratio, 3.2; 95% CI, 1.4-7.5). Similarly, future T1MI was more likely to occur among patients with index T1MI (hazard ratio, 3.0; 95% CI, 1.2-7.4). Conclusions and Relevance Among patients with T2MI, tachyarrhythmia and hypertension were responsible for more than two-thirds of T2MI cases. While T2MI and T1MI had comparable all-cause and cardiovascular mortality at 2 years, patients with tachyarrhythmia or hypertension as their underlying trigger of T2MI had a lower mortality compared with patients with hypotension, hypoxemia, or anemia. Future T2MI occurred 3-fold more frequently among patients with T2MI vs T1MI as the index event. Improved understanding of the specifics of patients with T2MI should help improve management strategies.
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Affiliation(s)
- Tania Coscia
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Division of Cardiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Òscar Miró
- Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Emergency Department, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Zurich, Switzerland
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Ana Yufera Sanchez
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Bernhard Okamura
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Samyut Shrestha
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - Katharina Hausknecht
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
| | - F Javier Martín-Sánchez
- Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Hospital Clínico San Carlos, Madrid, Spain
| | - Michael Christ
- Emergency Department, Kantonsspital Luzern, Lucerne, Switzerland
| | - Damian Kawecki
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Katowice, Katowice, Poland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Karin Wildi
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Critical Care Research Group, The Prince Charles Hospital, Brisbane and University of Queensland, Brisbane, Australia
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy.,Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Leipzig, Germany
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Global Research on Acute Conditions Team (GREAT) Network, Rome, Italy
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Troester V, Strebel I, Nestelberger T, Boeddinghaus J, Rubini Gimenez M, Lopez-Ayala P, Koechlin L, Glarner N, Prepoudis A, Miró Ò, Martin-Sanchez FJ, Kawecki D, Keller DI, Twerenbold R, Mueller C. Association of Previous Myocardial Infarction and Time to Presentation With Suspected Acute Myocardial Infarction. J Am Heart Assoc 2020; 10:e017829. [PMID: 33356355 PMCID: PMC7955506 DOI: 10.1161/jaha.120.017829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Valentina Troester
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Ivo Strebel
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Maria Rubini Gimenez
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy.,Department of Internal Medicine and Cardiology Heart Center Leipzig-University Hospital Leipzig Germany
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Luca Koechlin
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy.,Department of Cardiac Surgery University Hospital Basel Basel Switzerland
| | - Noemi Glarner
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Alexandra Prepoudis
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Òscar Miró
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Emergency Department Hospital Clinic Barcelona Catalonia Spain
| | - F Javier Martin-Sanchez
- Global research on Acute Conditions Team Network Rome Italy.,Servicio de Urgencias Hospital Clínico San Carlos Madrid Spain
| | - Damian Kawecki
- Global research on Acute Conditions Team Network Rome Italy.,2nd Department of Cardiology School of Medicine With the Division of Dentistry in Zabrze Medical University of Katowice Katowice Poland
| | - Dagmar I Keller
- Emergency Department University Hospital Zurich Zurich Switzerland
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel and Department of Cardiology University Hospital BaselUniversity of Basel Switzerland.,Global research on Acute Conditions Team Network Rome Italy
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