Comparison between type-2 and type-1 myocardial infarction:clinical features,treatment strategies and outcomes

Objective To assess the differences in incidence,clinical features,current treatment strategies and outcome in patients with type-2 vs.type-1 acute myocardial infarction(AMI).Methods We included 824 consecutive patients with a diagnosis of type-1 or type-2 AMI.During index hospitalization,clinical features and treatment strategies were collected in detail.At 1-year follow-up,mortality,stroke,non-fatal myocardial infarction and major bleeding were recorded.Results Type-1 AMI was present in 707(86%) of the cases while 117(14%) were classified as type-2.Patients with type-2 AMI were more frequently female and had higher co-morbidities such as diabetes,previous non-ST segment elevation acute coronary syndromes,impaired renal function,anaemia,atrial fibrillation and malignancy.However,preserved left ventricular ejection fraction and normal coronary arteries were more frequently seen,an invasive treatment was less common,and anti-platelet medications,statins and beta-blockers were less prescribed in patients with type-2 AMI.At 1-year follow-up,type-2 AMI was associated with a higher crude mortality risk(HR:1.75,95%CI:1.14-2.68;P = 0.001),but this association did not remain significant after multivariable adjustment(P = 0.785).Furthermore,we did not find type-2 AMI to be associated with other clinical outcomes.Conclusions In this real-life population,compared with type-1,typc-2 AMI were predominantly women and had more co-morbidities.Invasive treatment strategies and cardioprotective medications were less used in type-2,while the 1-year clinical outcomes were similar.