Incident Type 2 Myocardial Infarction in a Cohort of Patients Undergoing Coronary or Peripheral Arterial Angiography
Incident Type 2 Myocardial Infarction in a Cohort of Patients Undergoing Coronary or Peripheral Arterial Angiography
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DOI：
10.1161/circulationaha.116.023052
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发表时间：
2017-01-10
期刊：
影响因子：
37.8
通讯作者：
Januzzi, James L., Jr.
中科院分区：
文献类型：
--
作者：
Gaggin, Hanna K.;Liu, Yuyin;Januzzi, James L., Jr.
背景：尽管人们日益认识到 2 型心肌梗死（T2MI；与供需不匹配有关），但对其危险因素或其与结局的关系知之甚少。 方法：前瞻性纳入接受冠状动脉或外周血管造影（有或没有干预）的单中心患者队列，并随访 1 型和 T2MI 事件以及主要不良心血管事件（MACE，包括全因死亡、非致死性心肌梗死 [MI]、心力衰竭、中风、短暂性脑缺血的复合事件）发作、外周动脉并发症和心律失常）。 T2MI 的判定使用 MI 的第三个通用定义中的标准。获得基线特征、血液样本和血管造影信息。首次 MI 后的主要终点使用标志性分析进行评估，以比较首次事件的发生率，仅对 MI 之前有任何 MACE 病史的每个人进行审查并根据随访时间进行调整。使用 Cox 比例风险模型进行事件发生时间分析，将年龄和性别强制纳入所有模型，并通过使用逐步选项进行选择来评估其他协变量。 结果：纳入了 1251 名患者，随访中位数为 3.4 年。在这些患者中，152 名（12.2%）在随访期间患有 T2MI； T2MI 经常复发。 T2MI 的多变量预测因素包括年龄较大、收缩压较低、冠状动脉疾病史、心力衰竭、慢性阻塞性肺病、糖尿病、硝酸盐使用以及葡萄糖、N 末端 B 型钠尿肽前体和胱抑素 C 浓度升高。T2MI 患者的后续不良事件发生率高于非 T2MI 患者（每 100 人年：MACE，53.7 比 21.1，P
BACKGROUND: Despite growing recognition of type 2 myocardial infarction (T2MI; related to supply/demand mismatch), little is known about its risk factors or its association with outcome.METHODS: A single-center cohort of patients undergoing coronary or peripheral angiography with or without intervention was prospectively enrolled and followed for incident type 1 and T2MI, and major adverse cardiovascular events (MACE, a composite of all-cause death, nonfatal myocardial infarction [MI], heart failure, stroke, transient ischemic attack, peripheral arterial complication, and cardiac arrhythmia), as well. T2MI was adjudicated using criteria from the Third Universal Definition of MI. Baseline characteristics, blood samples, and angiography information were obtained. Major end points subsequent to first MI were assessed using landmark analyses to compare the rates of first events only where everyone with a prior history of any MACE before MI were censored and adjusted for follow-up times. Cox proportional hazard models were used for time-to-event analyses with age and sex forced into all models and additional covariates evaluated by using the stepwise option for the selection.RESULTS: One thousand two hundred fifty-one patients were enrolled and followed for a median of 3.4 years. Of these patients, 152 (12.2%) had T2MI during follow-up; T2MI was frequently recurrent. Multivariable predictors of T2MI were older age, lower systolic blood pressure, history of coronary artery disease, heart failure, chronic obstructive pulmonary disease, diabetes mellitus, nitrate use, and elevated concentrations of glucose, N-terminal pro-B type natriuretic peptide, and cystatin C. Patients with T2MI had higher rates of subsequent adverse events than those without T2MI (per 100 person-years: MACE, 53.7 versus 21.1, P