Higher non-cardiac mortality and lesser impact of early revascularization in patients with type 2 compared to type 1 acute myocardial infarction: results from the Tokyo CCU Network registry
Higher non-cardiac mortality and lesser impact of early revascularization in patients with type 2 compared to type 1 acute myocardial infarction: results from the Tokyo CCU Network registry
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DOI：
10.1007/s00380-019-01350-z
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发表时间：
2019-07-01
影响因子：
1.5
通讯作者：
Takayama, Morimasa
中科院分区：
文献类型：
--
作者：
Higuchi, Satoshi;Suzuki, Makoto;Takayama, Morimasa
由于2型急性心肌梗死(AMI)的定义不明确，这种疾病的特征在不同的研究中有所不同。2型心肌梗死的临床意义尚不清楚。我们调查了2010至2014年间东京心血管护理单位(CCU)网络注册情况。比较1型和2型急性心肌梗死患者临床特征的差异及血管重建的影响。队列研究包括12514名住在CCU的患者(1型急性心肌梗死12023例；2型急性心肌梗死491例；平均年龄68+/-15岁；75%男性)。对11402例(95%)1型急性心肌梗死患者和427例(87%)2型急性心肌梗死患者进行了冠状动脉造影(p<；0.001)。2型心肌梗死与较高的住院死亡率(1型，769(6.4%)；2型，54(11.0%)；调整优势比(OR)1.64；95%可信区间(CI)1.12-2.41；p=0.011)和更高的非心脏死亡率(调整OR2.19；95%CI 1.33-3.62；p=0.002)有关，但与1型心肌梗死相比心脏死亡率相似(调整OR1.17；95%CI 0.71-1.91；P=0.539)。发病后24小时内行经皮冠状动脉介入治疗的1型患者住院病死率较低(OR0.47；95%CI0.40~0.55；p<；0.001)，但与2型患者(OR1.09；95%CI0.62~1.94；p=0.763)无关。经多因素Logistic回归分析和倒置概率加权调整后，结果仍然成立。总而言之，由于非心源性死亡较高，2型急性心肌梗死患者的住院病死率较高。可能需要更精确的定义，重点放在合并症的治疗上，因为2型心肌梗死的治疗策略可能不同于1型心肌梗死。
As the definition of type 2 acute myocardial infarction (AMI) is obscure, the characteristics of this disease vary among studies. The clinical significance of type 2 AMI is unclear. We surveyed the Tokyo Cardiovascular Care Unit (CCU) Network registry between 2010 and 2014. The difference in clinical characteristics and the impact of revascularization in patients with type 1 and type 2 AMI were evaluated. The cohort study included 12514 patients admitted to CCU (type 1 AMI, 12023; type 2 AMI, 491; mean age, 68 +/- 15 years; 75% male). Coronary angiography was performed in 11402 patients (95%) with type 1 AMI and 427 (87%) with type 2 AMI (p < 0.001). Type 2 AMI was associated with higher in-hospital mortality (type 1 AMI, 769 (6.4%); type 2 AMI, 54 (11.0%); adjusted odds ratio (OR) 1.64; 95% confidence interval (CI) 1.12-2.41; p = 0.011) and higher non-cardiac mortality (adjusted OR 2.19; 95% CI 1.33-3.62; p = 0.002), but similar cardiac mortality rate compared to type 1 AMI (adjusted OR 1.17; 95% CI 0.71-1.91; p = 0.539). Percutaneous coronary intervention (PCI) within 24 h after the onset was associated with lower in-hospital mortality in those with type 1 AMI (OR 0.47; 95% CI 0.40-0.55; p < 0.001), but not in those with type 2 AMI (OR 1.09; 95% CI 0.62-1.94; p = 0.763). The results persisted after adjustment for multivariate logistic regression analysis and inverted probability weighting. In conclusion, patients with type 2 AMI had higher in-hospital mortality owing to higher non-cardiac death. More refined definitions focusing on the treatment of comorbidities may be required, as the treatment strategy for type 2 AMI can be different from that for type 1 AMI.