Twelve-Month Outcomes of Patients With Myocardial Injury not Due to Type-1 Myocardial Infarction

被引:0
作者
Rocheleau, Simon [1 ]
Eng-Frost, Joanne [1 ]
Lambrakis, Kristina [1 ,3 ]
Khan, Ehsan [1 ]
Chiang, Brian [1 ]
Wattchow, Naomi [1 ]
Steele, Simon [1 ]
Lorensini, Scott [1 ]
Lehman, Sam J. [1 ,2 ]
Papendick, Cynthia [4 ]
Chew, Derek P. [1 ,2 ,3 ,5 ]
机构
[1] Flinders Univ South Australia, Coll Med & Publ Hlth, Adelaide, SA, Australia
[2] South Australian Hlth & Med Res Inst, Adelaide, SA, Australia
[3] South Australian Dept Hlth, Adelaide, SA, Australia
[4] Univ Adelaide, Adelaide, SA, Australia
[5] Flinders Univ S Australia, Flinders Dr, Bedford Pk, SA 5042, Australia
关键词
Troponin; Myocardial infarction; Myocardial injury; Clinical outcomes; ACUTE CORONARY SYNDROMES; GUIDELINES; TROPONIN; SOCIETY;
D O I
10.1016/j.hlc.2023.04.299
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Diagnosis of acute myocardial infarction (AMI) requires a combination of elevated cardiac troponins, and clinical or echocardiographic evidence of coronary ischaemia. Identification of patients with a high likelihood of coronary plaque rupture (Type 1 myocardial infarction [MI]) is crucial as it is these patients for whom coronary intervention has been well-established to provide benefit and reduce subsequent coronary ischemic events. However, high-sensitivity cardiac troponin (hs-cTn) assays have increasingly identified patients with hs-cTn elevations not due to Type 1 MI where recommendations for ongoing care are currently limited. Understanding the profile and clinical outcomes for these patients may inform the development of an emerging evidence-base. Methods Using two previously published studies (hs-cTnT study n=1,937, RAPID-TnT study n=3,270) and the Fourth Universal Definition of MI, index presentations of patients to South Australian emergency departments with suspected AMI, defined by high sensitivity cardiac troponin T (hs-cTnT) greater than the upper reference limit (14 ng/L) and without obvious corresponding ischaemia on electrocardiogram (ECG), were classified as either Type 1 MI (T1MI), Type 2 MI (T2MI), acute myocardial injury (AI), or chronic myocardial injury (CI). Patients with non-elevated hs-cTnT (defined as ,14 ng/L) were excluded. Out-comes assessed included death, MI, unstable angina, and non-coronary cardiovascular events within 12 months.Results In total, 1,192 patients comprising 164 (13.8%) T1MI, 173 (14.5%) T2MI/AI, and 855 (71.7%) CI were included. The rate of death or recurrent acute coronary syndrome was greatest in patients with T1MI, but also occurred with moderate frequency in Type 2 MI/AI and CI (T1MI: 32/164 [19.5%]; T2MI/AI: 24/173 [13.1%]; CI:116/885 [13.6%]; p=0.008). Of all the deaths observed, 74% occurred among those with an initial index diagnostic classification of CI. After adjusting for age, gender and baseline comorbidities, the relative hazard ratios for non-coronary cardiovascular readmissions were similar across all groups: Type 2 MI/AI: 1.30 (95% confidence interval 0.99-1.72, p=0.062); CI: 1.10 (95% confidence interval 0.61-2.00, p=0.75).Conclusions Non-T1MI accounted for the majority of patients presenting with elevated hs-cTnT without ischaemia on ECG. Patients with T1MI had the highest rates of death or recurrent AMI; however patients with T2MI/AI and CI experienced a substantial rate of non-coronary cardiovascular re-hospitalisations.
引用
收藏
页码:978 / 985
页数:8
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