Treatment and outcomes of type 2 myocardial infarction and myocardial injury compared with type 1 myocardial infarction.
Treatment and outcomes of type 2 myocardial infarction and myocardial injury compared with type 1 myocardial infarction.
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DOI：
10.1097/mca.0000000000000545
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发表时间：
2018-01
影响因子：
1.8
通讯作者：
Sedlis SP
中科院分区：
文献类型：
--
作者：
Smilowitz NR;Subramanyam P;Gianos E;Reynolds HR;Shah B;Sedlis SP
2型心肌梗死（MI）的定义是心脏生物标志物的上升和下降，以及由于心肌氧供应和需求不匹配而导致的缺血证据，而不存在不稳定的冠状动脉疾病（CAD）。心肌损伤相似，但不符合MI的临床标准。与1型MI相比，2型MI和心肌损伤的临床特征、管理和结局存在不确定性。确定了因心肌肌钙蛋白（cTnI）升高和降低而入住退伍军人事务部三级护理医院的患者。确定了MI和损伤亚型、表现、治疗和结局。1型MI、2型MI和心肌损伤分别发生在137、146和175例患者中。与1型MI幸存者相比，2型MI患者年龄较大（p=0.02），cTnI峰值较低（p<0.001），出院时接受阿司匹林和他汀类药物治疗的可能性较小（p<0.001）。两组患者的全因死亡率（中位随访1.8年）无差异（1型MI死亡率：29.9%，2型MI：30.8%，心肌损伤：29.7%;对数秩p=0.94）。在所有亚组中，心血管原因导致的死亡比例很高（1型MI：34.1%，2型MI：17.8%，心肌损伤：30.8%）。与1型MI患者相比，2型MI和心肌损伤患者接受CAD药物治疗的可能性更小。未观察到MI亚型之间全因死亡率的差异。需要进一步的研究来确定这些高危人群的最佳药物治疗和风险分层策略。
Type 2 myocardial infarction (MI) is defined by a rise and fall of cardiac biomarkers and evidence of ischemia without unstable coronary artery disease (CAD), due to a mismatch in myocardial oxygen supply and demand. Myocardial injury is similar but does not meet clinical criteria for MI. There is uncertainty regarding clinical characteristics, management and outcomes of type 2 MI and myocardial injury in comparison to type 1 MI. Patients admitted to a Veterans Affairs tertiary-care hospital with a rise and fall in cardiac troponin (cTnI) were identified. MI and injury subtypes, presentation, management, and outcomes were determined. Type 1 MI, type 2 MI, and myocardial injury occurred in 137, 146, and 175 patients, respectively. Patients with type 2 MI were older (p=0.02), had lower peak cTnI (p<0.001), and were less likely to receive aspirin and statin at discharge (p<0.001) than type 1 MI survivors. All-cause mortality (median follow-up 1.8 years) was not different between patient groups (type 1 MI mortality: 29.9%, type 2 MI: 30.8%, myocardial injury: 29.7%; log-rank p=0.94). A significant proportion of deaths were attributed to cardiovascular causes in all subgroups (type 1 MI: 34.1%, type 2 MI: 17.8%, myocardial injury: 30.8%). Patients with type 2 MI and myocardial injury were less likely to receive medical therapy for CAD than those with type 1 MI. No differences in all-cause mortality among MI subtypes were observed. Additional studies to determine optimal medical therapy and risk stratification strategies for these high-risk populations are warranted.