Contemporary Classification of Myocardial Injury Events in MESA: Defining Distinct Risk Factor Associations with Myocardial Infarction Type 1-5 and Acute Non-Ischemic Myocardial Injury

项目摘要/摘要 尽管显著下降，动脉粥样硬化性心血管疾病(ASCVD)仍是主要的死亡原因 全世界。致命性或非致命性急性心肌梗死(MI)在至少一半的患者中仍是最初的表现 这些病人。近年来，人们对心肌梗死的多种病因有了更多的了解 损伤，国际共识的定义现在包括心肌损伤的非缺血性原因和几个 病因上不同的心肌损伤亚型，包括心肌梗死亚型。然而，流行性感冒的基本流行病学 MI亚型和非缺血性心肌损伤以及这些类别之间的危险因素有何不同 明显缺乏和迫切需要的。对心肌炎流行病学的基本认识 伤害事件，包括传统和非传统危险因素与不同MI的不同关系 亚型，是推进这些主要死因的预测、预防和治疗所必需的。 动脉粥样硬化的多种族研究(MESA)是一项性别平衡的当代NHLBI心血管研究 具有广泛的基线参与者表型和事件监视的队列。在这项建议中，我们的目标是 系统地重新裁决14年来在梅萨收集的18,000多个临床事件。我们有 开发了创新工具，以提高裁决过程的准确性和效率。我们将使用这些数据 目的：确定特定急性心肌梗死亚型的发生率。我们将描述协会的规模和实力 个体急性心肌梗死亚型和急性心肌梗塞亚型的基线传统心血管危险因素和新心血管危险因素之间的关系 非缺血性心肌损伤。除了分析个别风险因素对具体情况的影响外 心肌损伤亚型，我们将利用因子分析来利用从多重风险中获得的信息 一个领域内的因素(例如，血栓形成、动脉粥样硬化和心肌损伤)相互作用 影响特定的心肌损伤亚型。 拟议研究的成功完成将确定队列中急性心肌梗死事件的类型和频率 美国目标预防人群的代表。首先对风险因素进行表征和量化 我们希望这个项目的发现能够更具体地确定患者的风险。 预防工作的预测和有效调整(精准医学)。这样的知识将导致 评估更明智地应用目前的治疗方法--例如，限制积极的抗血栓治疗 对于1型心肌梗死与2型心肌梗死风险最大的人群，在更高效的同时最大限度地提高收益和限制风险 利用医疗资源。此外，识别新的风险因素将支持探索新的 针对个别心肌损伤亚型的治疗途径。

PROJECT SUMMARY/ABSTRACT Despite marked declines, atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide. Fatal or non-fatal acute myocardial infarction (MI) remains the initial presentation in at least half of these patients. In recent years, reflective of the greater understanding of the many diverse causes of myocardial injury, international consensus definition now includes non-ischemic causes of myocardial injury and several etiologically distinct subtypes of myocardial injury, including subtypes of MI. However, the basic epidemiology of MI subtypes and non-ischemic myocardial injury and how risk factors differ between these categories is conspicuously lacking and critically needed. A fundamental understanding of the epidemiology of myocardial injury events, including differential relationship of traditional and nontraditional risk factors to the different MI subtypes, is needed to advance the prediction, prevention, and treatment of these leading causes of death. The Multi-Ethnic Study of Atherosclerosis (MESA) is a gender balanced contemporary NHLBI cardiovascular cohort with extensive baseline participant phenotyping and event surveillance. In this proposal, we aim to systematically re-adjudicate more than 18,000 clinical events collected in MESA over 14 years. We have developed innovative tools to enhance accuracy and efficiency of the adjudication process. We will use this data to ascertain the incidence of specific acute MI subtypes. We will delineate the size and strength of association between baseline traditional and novel cardiovascular risk factors with individual acute MI subtypes and acute non-ischemic myocardial injury. In addition to analyzing the impact of individual risk factors on specific myocardial injury subtypes, we will utilize factor analyses to leverage information gained from how multiple risk factors within a domain (e.g., thrombogenicity, atherosclerosis and myocardial damage) interact with each other to impact specific myocardial injury subtype. Successful completion of the proposed study will define the type and frequency of acute MI events in a cohort representative of the US target prevention population. By first characterizing and quantifying the risk factor profile, we expect the findings of this project to enable development of more specific individual patient risk prediction and effective tailoring of prevention efforts (precision medicine). Such knowledge will result in the evaluation of more judicious application of current therapies—e.g., limiting aggressive anti-thrombotic therapy for those at greatest risk for Type 1 versus Type 2 MI to maximize benefit and limit risk while more efficiently utilizing healthcare resources. Furthermore, identification of new risk factors will support exploration of novel therapeutic avenues that specifically target individual myocardial injury subtypes.