Publication details

Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction

Authors	NESTELBERGER T. PAŘENICA Jiří BOEDDINGHAUS J. BADERTSCHER P. TWERENBOLD R. WILDI K. BREITENBUCHER D. SABTI Z. PUELACHER C. GIMENEZ M.R. KOZHUHAROV N. STREBEL I. SAZGARY L. SCHNEIDER D. JANN J. DU FAY DE LAVALLAZ J. MIRO O. MARTIN-SANCHEZ F.J. MORAWIEC B. KAWECKI D. MUZYK P. KELLER D.I. GEIGY N. OSSWALD S. REICHLIN T. MUELLER C.
Year of publication	2017
Type	Article in Periodical
Magazine / Source	Journal of The American College of Cardiology
MU Faculty or unit	Faculty of Medicine
Citation
Web	http://dx.doi.org/10.1016/j.jacc.2017.07.774
Doi	http://dx.doi.org/10.1016/j.jacc.2017.07.774
Field	Cardiovascular diseases incl. cardiosurgery
Keywords	diagnosis; high-sensitivity cardiac troponin; type 2 myocardial infarction
Description	BACKGROUND Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice. OBJECTIVES This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need. METHODS The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI(2007)); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI(2012)). RESULTS Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI(2007) definition was 2.8% (n = 112). The application of the more liberal T2MI(2012) definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI(2012reclassified)). Among T2MI(2007), 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI(2012reclassified) patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI(2012reclassified), which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI(2007) (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI(2012reclassified) vs. T2MI(2007) and T1MI: p = 0.03 and 0.01, respectively). CONCLUSIONS T2MI(2012reclassified) has a substantially lower event-related mortality rate compared with T2MI(2007) and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587) (C) 2017 by the American College of Cardiology Foundation.