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

项目总结/摘要 尽管有显著下降，但动脉粥样硬化性心血管疾病（ASCVD）仍是死亡的主要原因。 国际吧致死性或非致死性急性心肌梗死（MI）仍然是至少一半的初始表现， 这些病人。近年来，反映了对心肌梗死的许多不同原因的更多了解， 损伤，国际共识的定义现在包括非缺血性原因的心肌损伤和几个 病因学上不同的心肌损伤亚型，包括MI亚型。然而， 心肌梗死亚型和非缺血性心肌损伤以及这些类别之间的风险因素差异是 明显缺乏和急需的。对心肌梗死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，需要推进这些主要死亡原因的预测，预防和治疗。 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， 具有广泛基线参与者表型和事件监测的队列。在本建议中，我们的目标是 系统地重新裁定MESA 14年来收集的18，000多起临床事件。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 以确定特定急性心肌梗死亚型的发病率。我们将描述关联的大小和强度 基线传统和新型心血管风险因素与个体急性MI亚型和急性 非缺血性心肌损伤。除了分析单个风险因素对特定 心肌损伤亚型，我们将利用因子分析来利用从多个风险 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。 成功完成拟定研究将确定队列中急性MI事件的类型和频率 代表美国的目标预防人群。通过首先描述和量化风险因素， 概况，我们期望该项目的结果能够开发更具体的个体患者风险 预防工作的预测和有效调整（精确医疗）。这样的知识将导致 评价当前疗法的更明智应用-例如，限制性积极抗血栓治疗 对于1型与2型MI风险最大的患者， 利用医疗资源。此外，识别新的风险因素将支持新的风险因素的探索。 专门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.