Use of objective evidence of myocardial ischemia to facilitate the diagnostic and prognostic distinction between type 2 myocardial infarction and myocardial injury
Use of objective evidence of myocardial ischemia to facilitate the diagnostic and prognostic distinction between type 2 myocardial infarction and myocardial injury
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DOI：
10.1177/2048872618787796
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发表时间：
2020-02-01
影响因子：
4.1
通讯作者：
Apple, Fred S.
中科院分区：
文献类型：
--
作者：
Sandoval, Yader;Smith, Stephen W.;Apple, Fred S.
目的：首先，描述如何使用急性心肌梗死标准来诊断1型（T1MI）和2型（T2MI）心肌梗死。其次，确定T2MI是否使用主观或客观标准。第三，根据是否存在心肌缺血与心肌损伤的客观证据来检查T2MI的预后。方法和结果：UTROPIA （NCT02060760）是一项前瞻性、观察性、队列研究，纳入了1640例连续急诊科患者，其中74例（4.5%）为T1MI， 103例（6.3%）为T2MI， 245例（15%）为心肌损伤。与T1MI相比，T2MI患者出现缺血性症状（97% vs. 83%）、Q波（24% vs. 1%）、新的ST-T波改变（74% vs. 51%）、新的局部壁运动异常（64% vs. 11%）和冠状动脉造影的罪魁祸首病变（59% vs. 0%）的可能性更小（均p < 0.05）
Aims:First, describe how acute myocardial infarction criteria are used to diagnose type 1 (T1MI) and 2 (T2MI) myocardial infarction. Second, determine whether subjective or objective criteria are used for T2MI. Third, examine outcomes for T2MI based on the presence or absence of objective evidence of myocardial ischemia compared with myocardial injury.Methods and results:Post-hoc analysis of UTROPIA (NCT02060760), a prospective, observational, cohort study involving 1640 consecutive emergency department patients with serial high-sensitivity cardiac troponin I among whom 74 (4.5%) had T1MI, 103 (6.3%) T2MI, and 245 (15%) myocardial injury. Compared with T1MI, patients with T2MI were less likely to have ischemic symptoms (97% vs. 83%), Q waves (24% vs. 1%), new ST-T wave changes (74% vs. 51%), new regional wall motion abnormality (64% vs. 11%), and a culprit lesion on coronary angiography (59% vs. 0%) (all p