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

被引：96

作者：

Nestelberger, Thomas ^{[1
,2
,3
,4
]}

Boeddinghaus, Jasper ^{[1
,2
,3
,4
]}

Badertscher, Patrick ^{[1
,2
,4
]}

Twerenbold, Raphael ^{[1
,2
,4
,5
]}

Wildi, Karin ^{[1
,2
,4
]}

Breitenbuecher, Dominik ^{[1
,2
,4
]}

Sabti, Zaid ^{[1
,2
,4
]}

Puelacher, Christian ^{[1
,2
,4
]}

Gimenez, Maria Rubini ^{[1
,2
,4
]}

Kozhuharov, Nikola ^{[1
,2
,4
]}

Strebel, Ivo ^{[1
,2
,4
]}

Sazgary, Lorraine ^{[1
,2
,4
]}

Schneider, Deborah ^{[1
,2
]}

Jann, Janina ^{[1
,2
]}

de lavallaz, Jeanne du Fay ^{[1
,2
,4
]}

Miro, Oscar ^{[4
,6
]}

Javier Martin-Sanchez, F. ^{[7
]}

Morawiec, Beata ^{[8
]}

Kawecki, Damian ^{[8
]}

Muzyk, Piotr ^{[8
]}

Keller, Dagmar I. ^{[9
]}

Geigy, Nicolas ^{[10
]}

Osswald, Stefan ^{[1
,2
]}

Reichlin, Tobias ^{[1
,2
,4
]}

Mueller, Christian ^{[1
,2
,4
]}

机构：

[1] Univ Basel, Univ Basel Hosp, Cardiovasc Res Inst Basel, Basel, Switzerland

[2] Univ Basel, Univ Basel Hosp, Dept Cardiol, Basel, Switzerland

[3] Univ Basel, Univ Hosp Basel, Dept Internal Med, Basel, Switzerland

[4] GREAT Network, Rome, Italy

[5] Hamburg Univ, Dept Gen & Intervent Cardiol, Heart Ctr, Hamburg, Germany

[6] Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain

[7] Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain

[8] Med Univ Silesia, Div Dent Zabrze, Sch Med, Dept Cardiol 2, Katowice, Poland

[9] Univ Hosp Zurich, Emergency Dept, Zurich, Switzerland

[10] Kantonsspital Liestal, Emergency Dept, Liestal, Switzerland

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2017年 / 70卷 / 13期

基金：

瑞士国家科学基金会;

关键词：

diagnosis; high-sensitivity cardiac troponin; type 2 myocardial infarction; SENSITIVITY CARDIAC TROPONIN; EARLY-DIAGNOSIS; I ASSAY; CLASSIFICATION; INJURY; RISK; RULE;

D O I：

10.1016/j.jacc.2017.07.774

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1558 / 1568

页数：11

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