BACKGROUND: Type 2 myocardial infarction (T2MI) occurs because of an acute imbalance in myocardial oxygen supply and demand in the absence of atherothrombosis. Despite being frequently encountered in clinical practice, the population-based incidence and trends remain unknown, and the long-term outcomes are incompletely characterized. METHODS: We prospectively recruited residents of Olmsted County, Minnesota, who experienced an event associated with a cardiac troponin T >99th percentile of a normal reference population (≥0.01 ng/mL) between January 1, 2003, and December 31, 2012. Events were retrospectively classified into type 1 myocardial infarction (T1MI, atherothombotic event), T2MI, or myocardial injury (troponin rise not meeting criteria for myocardial infarction [MI]) using the universal definition. Outcomes were long-term all-cause and cardiovascular mortality and recurrent MI. T2MI was further subclassified by the inciting event for supply/demand mismatch. RESULTS: A total of 5460 patients had at least one cardiac troponin T ≥0.01 ng/mL; 1365 of these patients were classified as index T1MI (age, 68.5±14.8 years; 63% male) and 1054 were classified as T2MI (age, 73.7±15.8 years; 46% male). The annual incidence of T1MI decreased markedly from 202 to 84 per 100 000 persons between 2003 and 2012 (P<0.001), whereas the incidence of T2MI declined from 130 to 78 per 100 000 persons (P=0.02). In comparison with patients with T1MI, patients with T2MI had higher long-term all-cause mortality after adjustment for age and sex, driven by early and noncardiovascular death. Rates of cardiovascular death were similar after either type of MI (hazard ratio, 0.8 [95% CI, 0.7-1.0], P=0.11). Subclassification of T2MI by cause demonstrated a more favorable prognosis when the principal provoking mechanism was arrhythmia, in comparison with postoperative status, hypotension, anemia, and hypoxia. After index T2MI, the most common MI during follow-up was a recurrent T2MI, whereas the occurrence of a new T1MI was relatively rare (estimated rates at 5 years, 9.7% and 1.7%). CONCLUSIONS: There has been an evolution in the type of MI occurring in the community over a decade, with the incidence of T2MI now being similar to T1MI. Mortality after T2MI is higher and driven by early and noncardiovascular death. The provoking mechanism of supply/demand mismatch affects long-term survival. These findings underscore the healthcare burden of T2MI and provide benchmarks for clinical trial design.
BACKGROUND:Type 2 myocardial infarction (T2MI) occurs because of an acute imbalance in myocardial oxygen supply and demand in the absence of atherothrombosis. Despite being frequently encountered in clinical practice, the population-based incidence and trends remain unknown, and the long-term outcomes are incompletely characterized. METHODS: We prospectively recruited residents of Olmsted County, Minnesota, who experienced an event associated with a cardiac troponin T >99th percentile of a normal reference population (≥0.01 ng/mL) between January 1, 2003, and December 31, 2012. Events were retrospectively classified into type 1 myocardial infarction (T1MI, atherothombotic event), T2MI, or myocardial injury (troponin rise not meeting criteria for myocardial infarction [MI]) using the universal definition. Outcomes were long-term all-cause and cardiovascular mortality and recurrent MI. T2MI was further subclassified by the inciting event for supply/demand mismatch. RESULTS: A total of 5460 patients had at least one cardiac troponin T ≥0.01 ng/mL; 1365 of these patients were classified as index T1MI (age, 68.5±14.8 years; 63% male) and 1054 were classified as T2MI (age, 73.7±15.8 years; 46% male). The annual incidence of T1MI decreased markedly from 202 to 84 per 100 000 persons between 2003 and 2012 (P<0.001), whereas the incidence of T2MI declined from 130 to 78 per 100 000 persons (P=0.02). In comparison with patients with T1MI, patients with T2MI had higher long-term all-cause mortality after adjustment for age and sex, driven by early and noncardiovascular death. Rates of cardiovascular death were similar after either type of MI (hazard ratio, 0.8 [95% CI, 0.7-1.0], P=0.11). Subclassification of T2MI by cause demonstrated a more favorable prognosis when the principal provoking mechanism was arrhythmia, in comparison with postoperative status, hypotension, anemia, and hypoxia. After index T2MI, the most common MI during follow-up was a recurrent T2MI, whereas the occurrence of a new T1MI was relatively rare (estimated rates at 5 years, 9.7% and 1.7%). CONCLUSIONS: There has been an evolution in the type of MI occurring in the community over a decade, with the incidence of T2MI now being similar to T1MI. Mortality after T2MI is higher and driven by early and noncardiovascular death. The provoking mechanism of supply/demand mismatch affects long-term survival. These findings underscore the healthcare burden of T2MI and provide benchmarks for clinical trial design.
Authors: Shanthi Mendis; Kristian Thygesen; Kari Kuulasmaa; Simona Giampaoli; Markku Mähönen; Kathleen Ngu Blackett; Liu Lisheng Journal: Int J Epidemiol Date: 2010-10-05 Impact factor: 7.196
Authors: Yader Sandoval; Stephen W Smith; Anne Sexter; Sarah E Thordsen; Charles A Bruen; Michelle D Carlson; Kenneth W Dodd; Brian E Driver; Yan Hu; Katherine Jacoby; Benjamin K Johnson; Sara A Love; Johanna C Moore; Karen Schulz; Nathaniel L Scott; Fred S Apple Journal: Am J Med Date: 2017-07-21 Impact factor: 4.965
Authors: Véronique L Roger; Susan A Weston; Yariv Gerber; Jill M Killian; Shannon M Dunlay; Allan S Jaffe; Malcolm R Bell; Jan Kors; Barbara P Yawn; Steven J Jacobsen Journal: Circulation Date: 2010-02-08 Impact factor: 29.690
Authors: Lotte Saaby; Tina Svenstrup Poulsen; Susanne Hosbond; Torben Bjerregaard Larsen; Axel Cosmus Pyndt Diederichsen; Jesper Hallas; Kristian Thygesen; Hans Mickley Journal: Am J Med Date: 2013-07-12 Impact factor: 4.965
Authors: Kristina Lambrakis; John K French; Ian A Scott; Tom Briffa; David Brieger; Michael E Farkouh; Harvey White; Anthony Ming-Yu Chuang; Kathryn Tiver; Stephen Quinn; Billingsley Kaambwa; Matthew Horsfall; Erin Morton; Derek P Chew Journal: Am Heart J Date: 2018-10-25 Impact factor: 4.749
Authors: Véronique L Roger; Steven J Jacobsen; Susan A Weston; Tauqir Y Goraya; Jill Killian; Guy S Reeder; Thomas E Kottke; Barbara P Yawn; Robert L Frye Journal: Ann Intern Med Date: 2002-03-05 Impact factor: 25.391
Authors: Kevin C Floyd; Jorge Yarzebski; Frederick A Spencer; Darleen Lessard; James E Dalen; Joseph S Alpert; Joel M Gore; Robert J Goldberg Journal: Circ Cardiovasc Qual Outcomes Date: 2009-03-05
Authors: Xiongyi Han; Myung Ho Jeong; Liyan Bai; Joon Ho Ahn; Dae Young Hyun; Kyung Hoon Cho; Min Chul Kim; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Youngkeun Ahn Journal: Cardiovasc Diagn Ther Date: 2022-02
Authors: Manish Kumar; Shivaraj Patil; Lucas Da Cunha Godoy; Chia-Ling Kuo; Helen Swede; George A Kuchel; Kai Chen Journal: Front Cardiovasc Med Date: 2022-06-06
Authors: Anda Bularga; Caelan Taggart; Filip Mendusic; Dorien M Kimenai; Ryan Wereski; Matthew T H Lowry; Kuan K Lee; Amy V Ferry; Stacey S Stewart; David A McAllister; Anoop S V Shah; Atul Anand; David E Newby; Nicholas L Mills; Andrew R Chapman Journal: JAMA Netw Open Date: 2022-07-01
Authors: Bernard R Chaitman; Karen P Alexander; Derek D Cyr; Jeffrey S Berger; Harmony R Reynolds; Sripal Bangalore; William E Boden; Renato D Lopes; Marcin Demkow; Gian Piero Perna; Robert K Riezebos; Edward O McFalls; Subhash Banerjee; Akshay Bagai; Gilbert Gosselin; Sean M O'Brien; Frank W Rockhold; David D Waters; Kristian A Thygesen; Gregg W Stone; Harvey D White; David J Maron; Judith S Hochman Journal: Circulation Date: 2020-12-03 Impact factor: 29.690
Authors: Elena Myasoedova; John M Davis; Veronique L Roger; Sara J Achenbach; Cynthia S Crowson Journal: J Rheumatol Date: 2021-02-15 Impact factor: 5.346