Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.
Assessment of Oxygen Supply-Demand Imbalance and Outcomes Among Patients With Type 2 Myocardial Infarction: A Secondary Analysis of the High-STEACS Cluster Randomized Clinical Trial.
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2型心肌梗死患者氧供需失衡和预后的评估：高STEACS随机临床试验的二次分析。
DOI：
10.1001/jamanetworkopen.2022.20162
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发表时间：
2022-07-01
影响因子：
13.8
通讯作者：
Chapman, Andrew R.
中科院分区：
文献类型：
--
作者：
Bularga, Anda;Taggart, Caelan;Mendusic, Filip;Kimenai, Dorien M.;Wereski, Ryan;Lowry, Matthew T. H.;Lee, Kuan K.;Ferry, Amy V.;Stewart, Stacey S.;McAllister, David A.;Shah, Anoop S. V.;Anand, Atul;Newby, David E.;Mills, Nicholas L.;Chapman, Andrew R.
2型心肌梗死患者血氧供需失衡相关因素的临床结果如何？在一项随机临床试验的二级分析中，快速性心律失常是与氧供需失衡相关的最常见因素，发生在55%的2型心肌梗死患者中，并且与较好的预后相关。与2型心肌梗死相关的全身性疾病，表现为贫血、低氧血症、低血压或严重高血压，不太常见，但这些疾病的患者具有相似的特征，全因死亡率最高。与2型心肌梗死患者氧供需失衡相关的潜在因素可能提供有用的预后信息。2型心肌梗死的发生与心肌氧供需失衡相关的多种因素有关，这些因素可能导致不同的不良结局风险。目的：探讨2型心肌梗死患者血氧供需失衡相关因素的患病率及预后。在这项在苏格兰10家二级和三级医疗医院进行的阶梯式随机临床试验的二级分析中，确定了2013年6月10日至2016年3月3日确诊为1型或2型心肌梗死的6096例患者，并于2018年8月28日报道了研究结果。该试验招募了疑似急性冠状动脉综合征的连续患者。根据《心肌梗死第四种通用定义》确定心肌梗死的诊断，并明确2型心肌梗死中与氧供需失衡相关的主要因素。这个二次分析没有预先指定。统计分析时间为2020年7月7日- 30日。高灵敏度心肌肌钙蛋白I测定的实施。2型心肌梗死患者1年全因死亡与氧供需失衡相关因素的比较6096例患者中（女性2602例[43%]，中位年龄70岁[IQR， 58-80岁]），1型心肌梗死4981例，2型心肌梗死1115例。与氧供需失衡相关的最常见因素是心律失常（1115例中616例[55%]），其次是低氧血症（1115例中219例[20%]）、贫血（1115例中95例[9%]）、低血压（1115例中89例[8%]）、严重高血压（1115例中61例[5%]）和冠状动脉机制（1115例中35例[3%]）。1年后，15%的1型心肌梗死患者（4981例中720例）和23%的2型心肌梗死患者（1115例中285例）出现全因死亡。与1型心肌梗死患者相比，低氧血症（校正优势比[aOR]， 2.35; 95% CI, 1.72-3.18）和贫血（校正优势比[aOR]， 1.83; 95% CI, 1.14-2.88）导致的2型心肌梗死的死亡风险最高，而由速性心律失常（aOR, 0.83; 95% CI, 0.65-1.06）或冠状动脉机制（aOR, 1.07; 95% CI, 0.17-3.86）导致的2型心肌梗死的死亡风险与1型心肌梗死患者相似。在一项随机临床试验的二级分析中，2型心肌梗死后的死亡率与与氧供需失衡相关的潜在病因有关。大多数2型心肌梗死伴有快速心律失常，预后较好，而低氧血症和贫血占三分之一，死亡率是1型心肌梗死的两倍。临床医生在确定哪些病例需要进行治疗以改善患者预后时，应考虑这些差异结果。这项随机临床试验的二级分析评估了2型心肌梗死患者中与氧供需失衡相关的不同因素的患病率和结局。
What are the clinical outcomes of the different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction? In this secondary analysis of a randomized clinical trial, tachyarrhythmia was the most common factor associated with oxygen supply-demand imbalance, occurring in 55% of all patients with type 2 myocardial infarction, and was associated with better outcomes. Systemic illnesses associated with type 2 myocardial infarction, which presented with anemia, hypoxemia, hypotension, or severe hypertension, were less common, but patients with these illnesses shared similar characteristics and had the highest rates of all-cause death. The underlying factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction may provide useful prognostic information. Type 2 myocardial infarction occurs owing to multiple factors associated with myocardial oxygen supply-demand imbalance, which may confer different risks of adverse outcomes. To evaluate the prevalence and outcomes of different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction. In this secondary analysis of a stepped-wedge, cluster randomized clinical trial conducted at 10 secondary and tertiary care hospitals in Scotland, 6096 patients with an adjudicated diagnosis of type 1 or type 2 myocardial infarction from June 10, 2013, to March 3, 2016, were identified, and the findings were reported on August 28, 2018. The trial enrolled consecutive patients with suspected acute coronary syndrome. The diagnosis of myocardial infarction was adjudicated according to the Fourth Universal Definition of Myocardial Infarction and the primary factor associated with oxygen supply-demand imbalance in type 2 myocardial infarction was defined. This secondary analysis was not prespecified. Statistical analysis was performed from July 7 to 30, 2020. Implementation of a high-sensitivity cardiac troponin I assay. All-cause death at 1 year according to the factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction. Of 6096 patients (2602 women [43%]; median age, 70 years [IQR, 58-80 years]), 4981 patients had type 1 myocardial infarction, and 1115 patients had type 2 myocardial infarction. The most common factor associated with oxygen supply-demand imbalance was tachyarrhythmia (616 of 1115 [55%]), followed by hypoxemia (219 of 1115 [20%]), anemia (95 of 1115 [9%]), hypotension (89 of 1115 [8%]), severe hypertension (61 of 1115 [5%]), and coronary mechanisms (35 of 1115 [3%]). At 1 year, all-cause mortality occurred for 15% of patients (720 of 4981) with type 1 myocardial infarction and 23% of patients (285 of 1115) with type 2 myocardial infarction. Compared with patients with type 1 myocardial infarction, those with type 2 myocardial infarction owing to hypoxemia (adjusted odds ratio [aOR], 2.35; 95% CI, 1.72-3.18) and anemia (aOR, 1.83; 95% CI, 1.14-2.88) were at greatest risk of death, whereas those with type 2 myocardial infarction owing to tachyarrhythmia (aOR, 0.83; 95% CI, 0.65-1.06) or coronary mechanisms (aOR, 1.07; 95% CI, 0.17-3.86) were at similar risk of death as patients with type 1 myocardial infarction. In this secondary analysis of a randomized clinical trial, mortality after type 2 myocardial infarction was associated with the underlying etiologic factor associated with oxygen supply-demand imbalance. Most type 2 myocardial infarctions were associated with tachyarrhythmia, with better prognosis, whereas hypoxemia and anemia accounted for one-third of cases, with double the mortality of type 1 myocardial infarction. These differential outcomes should be considered by clinicians when determining which cases need to be managed if patient outcomes are to improve. ClinicalTrials.gov Identifier: NCT01852123 This secondary analysis of a randomized clinical trial evaluates the prevalence and outcomes of different factors associated with oxygen supply-demand imbalance among patients with type 2 myocardial infarction.
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