Type 2 myocardial infarction: A descriptive analysis and comparison with type 1 myocardial infarction
Type 2 myocardial infarction: A descriptive analysis and comparison with type 1 myocardial infarction
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DOI：
10.1016/j.jjcc.2015.04.001
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发表时间：
2016-01-01
影响因子：
2.5
通讯作者：
Kornowski, Ran
中科院分区：
文献类型：
--
作者：
Landes, Uri;Bental, Tamir;Kornowski, Ran
背景资料：虽然“斑块破裂”是1型心肌梗死（T1 MI）的范例，但T2 MI是继发于氧供需不匹配的心肌坏死。方法：回顾性分析2007 - 2012年以色列拉宾心脏病中心确诊的T2心肌梗死患者的临床资料。描述性分析后，我们使用多变量时间依赖模型来估计T2 MI与30天，1年和5年全因死亡率和主要不良心血管事件（MACE）的风险的关联，并将其与年龄，性别和心电图变化相匹配的T1 MI组进行比较。结果：该研究包括107 T2 MI（和107 T1 MI）患者。败血症、贫血和房颤是最常见的病因。22%的T2 MI患者接受了三联抗血栓治疗（T1 MI患者为82%，p < 0.001）。25%的患者接受了紧急经皮冠状动脉介入治疗。血管造影显示29%的T2 MI患者组中存在急性斑块破裂。与T1 MI相比，T2 MI与更高的全因死亡率相关：30天时的调整风险比为7.14（1.31-38.9），1年时为3.42（1.51-7.75），5年随访时为2.08（1.14-3.81）。T2和T1 MI patients.Conclusions：最常见的T2 MI触发因素是败血症，贫血和心房颤动。与T1 MI人群相比，T2 MI与更高的短期和长期死亡率相关，但心血管死亡率和MACE风险相同。多达30%的患者可能存在斑块破裂，实际上患有T1 MI。(C)2015年由Elsevier Ltd代表日本心脏病学院发布。
Background: While 'plaque rupture' is the paradigm of type 1 myocardial infarction (T1MI), T2MI is myocardial necrosis secondary to oxygen supply-demand mismatch. Being a heterogeneous and rather newly defined group, data are lacking about T2MI.Methods: A retrospective review of medical records of patients diagnosed with T2MI in the Rabin Cardiology Center, Israel between the years 2007 and 2012 was performed. Following a descriptive analysis, we used multivariate time dependent models to estimate the association of T2MI with the risk for 30-day, 1-year, and 5-year all-cause-mortality and major adverse cardiovascular events (MACE), and compared it to a T1MI group matched for age, gender and electrocardiographic changes.Results: The study included 107 T2MI (and 107 T1MI) patients. Sepsis, anemia, and atrial fibrillation were the most common etiologies. Triple anti-thrombotic therapy was given to 22% of T2MI patients (vs. 82% of T1MI patients, p < 0.001). Twenty-five percent were managed using urgent percutaneous coronary intervention. Angiography unmasked acute plaque rupture in 29% of T2MI patients group. Compared to T1MI, T2MI was associated with higher all-cause-mortality rate: adjusted-hazard-ratio 7.14 (1.31-38.9) at 30 days, 3.42 (1.51-7.75) at 1 year, and 2.08 (1.14-3.81) at 5 years follow-up. MACE risk was consistent between T2 and T1MI patients.Conclusions: The most common T2MI triggers are sepsis, anemia, and atrial fibrillation. Compared to a T1MI population, T2MI is associated with higher short- and long-term mortality rates but equal cardiovascular mortality and MACE risk. As many as 30% may harbor plaque rupture and in fact have T1MI. (C) 2015 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.