Type 2 myocardial infarction in clinical practice
Type 2 myocardial infarction in clinical practice
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DOI：
10.1136/heartjnl-2014-306093
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发表时间：
2015-01-15
期刊：
影响因子：
5.7
通讯作者：
Lindahl, Bertil
中科院分区：
文献类型：
--
作者：
Baron, Tomasz;Hambraeus, Kristina;Lindahl, Bertil
目的我们的目的是评估不同的发病率，临床特征，2型与1型急性心肌梗死（AMI）患者的当前治疗策略和结局。方法和结果2011年期间，瑞典所有20138例诊断为AMI的住院病例在瑞典证据增强和发展网络系统中登记，根据2007年的心肌梗死（MI）的通用定义，将根据推荐疗法评估的心脏病的基础护理分为1-5型。1型AMI占88.5%，2型AMI占7.1%。2型AMI患者具有较高的年龄、女性、合并症、肾功能受损、贫血和心肌坏死程度较小的特征。虽然正常冠状动脉更常见（42.4% vs. 7.4%），但与1型AMI相比，2型AMI患者的侵入性治疗较不常见，抗血小板药物处方较少。与1型AMI组相比，2型AMI组的1年粗死亡率显著更高（24.7% vs. 13.5%，p< 0.001）。然而，调整后，2型AMI患者1年死亡率的HR为1.03（95%CI 0.86至1.23）。结论在这项现实生活研究中，7.1%的心肌梗死被归类为2型AMI。这些患者年龄较大，主要为女性，合并症较多。侵入性治疗策略和心脏保护药物的使用较少。2型AMI患者的粗死亡率高于1型MI患者。然而，调整后，1年死亡率相似。
Objective We aimed to assess differences in incidence, clinical features, current treatment strategies and outcome in patients with type 2 vs. type 1 acute myocardial infarction (AMI).Methods and results All 20 138 hospitalisations in Sweden with a diagnosis of AMI registered during 2011 in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies were classified into types 1-5 in accordance with the universal definition of myocardial infarction (MI) from 2007. Type 1 AMI was present in 88.5% of the cases while 7.1% were classified as type 2 AMI. Higher age, female sex, comorbidities, impaired renal function, anaemia and smaller extent of myocardial necrosis characterised patients with type 2 AMI. While normal coronary arteries were more frequently seen (42.4% vs. 7.4%), an invasive treatment was less common, and antiplatelet medications were less prescribed in patients with type 2 AMI compared with type 1 AMI. The group with type 2 AMI had significantly higher crude 1-year mortality compared with the group with type 1 AMI (24.7% vs. 13.5%, p< 0.001). However, after adjustment, the HR for 1-year mortality in patients with type 2 AMI was 1.03 (95% CI 0.86 to 1.23).Conclusions In this real-life study, 7.1% of myocardial infarctions were classified as type 2 AMI. These patients were older, predominantly women and had more comorbidities. Invasive treatment strategies and cardioprotective medications were less used. Patients with type 2 AMI had higher crude mortality compared with type 1 patients with MI. However, after adjustment, the 1-year mortality was similar.