Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury
BACKGROUND:Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury. METHODS:We identified co...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2018-03, Vol.137 (12), p.1236-1245 |
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| creator | Chapman, Andrew R Shah, Anoop S.V Lee, Kuan Ken Anand, Atul Francis, Oliver Adamson, Philip McAllister, David A Strachan, Fiona E Newby, David E Mills, Nicholas L |
| description | BACKGROUND:Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury.
METHODS:We identified consecutive patients (n=2122) with elevated cardiac troponin I concentrations (≥0.05 µg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the universal definition of myocardial infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (eg, nonfatal myocardial infarction or cardiovascular death) and noncardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.
RESULTS:The adjudicated index diagnosis was type 1 or 2 myocardial infarction or myocardial injury in 1171 (55.2%), 429 (20.2%), and 522 (24.6%) patients, respectively. At 5 years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were because of noncardiovascular causes (hazard ratio, 2.32; 95% confidence interval, 1.92–2.81 versus type 1 myocardial infarction). Despite this finding, the observed crude major adverse cardiovascular event rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for covariates (hazard ratio, 0.82; 95% confidence interval, 0.69–0.96). Coronary heart disease was an independent predictor of major adverse cardiovascular events in those with type 2 myocardial infarction or myocardial injury (hazard ratio, 1.71; 95% confidence interval, 1.31–2.24).
CONCLUSIONS:Despite an excess in noncardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events as those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.117.031806 |
| format | Article |
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METHODS:We identified consecutive patients (n=2122) with elevated cardiac troponin I concentrations (≥0.05 µg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the universal definition of myocardial infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (eg, nonfatal myocardial infarction or cardiovascular death) and noncardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.
RESULTS:The adjudicated index diagnosis was type 1 or 2 myocardial infarction or myocardial injury in 1171 (55.2%), 429 (20.2%), and 522 (24.6%) patients, respectively. At 5 years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were because of noncardiovascular causes (hazard ratio, 2.32; 95% confidence interval, 1.92–2.81 versus type 1 myocardial infarction). Despite this finding, the observed crude major adverse cardiovascular event rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for covariates (hazard ratio, 0.82; 95% confidence interval, 0.69–0.96). Coronary heart disease was an independent predictor of major adverse cardiovascular events in those with type 2 myocardial infarction or myocardial injury (hazard ratio, 1.71; 95% confidence interval, 1.31–2.24).
CONCLUSIONS:Despite an excess in noncardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events as those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.117.031806</identifier><identifier>PMID: 29150426</identifier><language>eng</language><publisher>United States: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Aged ; Aged, 80 and over ; Biomarkers - blood ; Cause of Death ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction - blood ; Myocardial Infarction - mortality ; Myocardial Infarction - pathology ; Myocardial Infarction - therapy ; Myocardium - metabolism ; Myocardium - pathology ; Necrosis ; Original s ; Prognosis ; Risk Assessment ; Risk Factors ; Time Factors ; Troponin I - blood ; Up-Regulation</subject><ispartof>Circulation (New York, N.Y.), 2018-03, Vol.137 (12), p.1236-1245</ispartof><rights>2018 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2017 The Authors.</rights><rights>2017 The Authors. 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5336-f51d6f30713c4a5a7cf32ebbf70034186af28f58ae571db3b1cd7e2d1defc76f3</citedby><cites>FETCH-LOGICAL-c5336-f51d6f30713c4a5a7cf32ebbf70034186af28f58ae571db3b1cd7e2d1defc76f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,3674,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29150426$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chapman, Andrew R</creatorcontrib><creatorcontrib>Shah, Anoop S.V</creatorcontrib><creatorcontrib>Lee, Kuan Ken</creatorcontrib><creatorcontrib>Anand, Atul</creatorcontrib><creatorcontrib>Francis, Oliver</creatorcontrib><creatorcontrib>Adamson, Philip</creatorcontrib><creatorcontrib>McAllister, David A</creatorcontrib><creatorcontrib>Strachan, Fiona E</creatorcontrib><creatorcontrib>Newby, David E</creatorcontrib><creatorcontrib>Mills, Nicholas L</creatorcontrib><title>Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>BACKGROUND:Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury.
METHODS:We identified consecutive patients (n=2122) with elevated cardiac troponin I concentrations (≥0.05 µg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the universal definition of myocardial infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (eg, nonfatal myocardial infarction or cardiovascular death) and noncardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.
RESULTS:The adjudicated index diagnosis was type 1 or 2 myocardial infarction or myocardial injury in 1171 (55.2%), 429 (20.2%), and 522 (24.6%) patients, respectively. At 5 years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were because of noncardiovascular causes (hazard ratio, 2.32; 95% confidence interval, 1.92–2.81 versus type 1 myocardial infarction). Despite this finding, the observed crude major adverse cardiovascular event rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for covariates (hazard ratio, 0.82; 95% confidence interval, 0.69–0.96). Coronary heart disease was an independent predictor of major adverse cardiovascular events in those with type 2 myocardial infarction or myocardial injury (hazard ratio, 1.71; 95% confidence interval, 1.31–2.24).
CONCLUSIONS:Despite an excess in noncardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events as those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biomarkers - blood</subject><subject>Cause of Death</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - pathology</subject><subject>Myocardial Infarction - therapy</subject><subject>Myocardium - metabolism</subject><subject>Myocardium - pathology</subject><subject>Necrosis</subject><subject>Original s</subject><subject>Prognosis</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Troponin I - blood</subject><subject>Up-Regulation</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUUtvEzEQthCIhpa_gMyNyxY_1vbuAaQoojRSIAil5Wh5vePGZXcd7N1W-fd1lVKRG6fRfK8Z6UPoPSXnlEr6cbH8ubhazTfL9ff55Txj6pxwWhH5As2oYGVRCl6_RDNCSF0oztgJepPSbV4lV-I1OmE1FaRkcoauV2G4KTYQe7yeRht6SNgP-IcZPQxjwr_8uMWb_Q4ww9_2wZrYetPh5eBMtKMPAzZDe8zcTnF_hl450yV4-zRP0dXFl83islitvy4X81VhBeeycIK20nGiKLelEUZZxxk0jVOE8JJW0jhWOVEZEIq2DW-obRWwlrbgrMrOU_T5kLubmh5am3-OptO76HsT9zoYr4-ZwW_1TbjToqoYEyQHfHgKiOHPBGnUvU8Wus4MEKakaS0l41QJkaX1QWpjSCmCez5DiX7sRR_3kjGlD71k77t__3x2_i0iCz4dBPehGyGm3910D1FvwXTj9j8OPADIH5_8</recordid><startdate>20180320</startdate><enddate>20180320</enddate><creator>Chapman, Andrew R</creator><creator>Shah, Anoop S.V</creator><creator>Lee, Kuan Ken</creator><creator>Anand, Atul</creator><creator>Francis, Oliver</creator><creator>Adamson, Philip</creator><creator>McAllister, David A</creator><creator>Strachan, Fiona E</creator><creator>Newby, David E</creator><creator>Mills, Nicholas L</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180320</creationdate><title>Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury</title><author>Chapman, Andrew R ; Shah, Anoop S.V ; Lee, Kuan Ken ; Anand, Atul ; Francis, Oliver ; Adamson, Philip ; McAllister, David A ; Strachan, Fiona E ; Newby, David E ; Mills, Nicholas L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5336-f51d6f30713c4a5a7cf32ebbf70034186af28f58ae571db3b1cd7e2d1defc76f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biomarkers - blood</topic><topic>Cause of Death</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - pathology</topic><topic>Myocardial Infarction - therapy</topic><topic>Myocardium - metabolism</topic><topic>Myocardium - pathology</topic><topic>Necrosis</topic><topic>Original s</topic><topic>Prognosis</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Troponin I - blood</topic><topic>Up-Regulation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chapman, Andrew R</creatorcontrib><creatorcontrib>Shah, Anoop S.V</creatorcontrib><creatorcontrib>Lee, Kuan Ken</creatorcontrib><creatorcontrib>Anand, Atul</creatorcontrib><creatorcontrib>Francis, Oliver</creatorcontrib><creatorcontrib>Adamson, Philip</creatorcontrib><creatorcontrib>McAllister, David A</creatorcontrib><creatorcontrib>Strachan, Fiona E</creatorcontrib><creatorcontrib>Newby, David E</creatorcontrib><creatorcontrib>Mills, Nicholas L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chapman, Andrew R</au><au>Shah, Anoop S.V</au><au>Lee, Kuan Ken</au><au>Anand, Atul</au><au>Francis, Oliver</au><au>Adamson, Philip</au><au>McAllister, David A</au><au>Strachan, Fiona E</au><au>Newby, David E</au><au>Mills, Nicholas L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2018-03-20</date><risdate>2018</risdate><volume>137</volume><issue>12</issue><spage>1236</spage><epage>1245</epage><pages>1236-1245</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>BACKGROUND:Type 2 myocardial infarction and myocardial injury are common in clinical practice, but long-term consequences are uncertain. We aimed to define long-term outcomes and explore risk stratification in patients with type 2 myocardial infarction and myocardial injury.
METHODS:We identified consecutive patients (n=2122) with elevated cardiac troponin I concentrations (≥0.05 µg/L) at a tertiary cardiac center. All diagnoses were adjudicated as per the universal definition of myocardial infarction. The primary outcome was all-cause death. Secondary outcomes included major adverse cardiovascular events (eg, nonfatal myocardial infarction or cardiovascular death) and noncardiovascular death. To explore competing risks, cause-specific hazard ratios were obtained using Cox regression models.
RESULTS:The adjudicated index diagnosis was type 1 or 2 myocardial infarction or myocardial injury in 1171 (55.2%), 429 (20.2%), and 522 (24.6%) patients, respectively. At 5 years, all-cause death rates were higher in those with type 2 myocardial infarction (62.5%) or myocardial injury (72.4%) compared with type 1 myocardial infarction (36.7%). The majority of excess deaths in those with type 2 myocardial infarction or myocardial injury were because of noncardiovascular causes (hazard ratio, 2.32; 95% confidence interval, 1.92–2.81 versus type 1 myocardial infarction). Despite this finding, the observed crude major adverse cardiovascular event rates were similar between groups (30.6% versus 32.6%), with differences apparent after adjustment for covariates (hazard ratio, 0.82; 95% confidence interval, 0.69–0.96). Coronary heart disease was an independent predictor of major adverse cardiovascular events in those with type 2 myocardial infarction or myocardial injury (hazard ratio, 1.71; 95% confidence interval, 1.31–2.24).
CONCLUSIONS:Despite an excess in noncardiovascular death, patients with type 2 myocardial infarction or myocardial injury have a similar crude rate of major adverse cardiovascular events as those with type 1 myocardial infarction. Identifying underlying coronary heart disease in this vulnerable population may help target therapies that could modify future risk.</abstract><cop>United States</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>29150426</pmid><doi>10.1161/CIRCULATIONAHA.117.031806</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
| subjects | Aged Aged, 80 and over Biomarkers - blood Cause of Death Female Humans Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - mortality Myocardial Infarction - pathology Myocardial Infarction - therapy Myocardium - metabolism Myocardium - pathology Necrosis Original s Prognosis Risk Assessment Risk Factors Time Factors Troponin I - blood Up-Regulation |
| title | Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury |
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