Avinainder Singh1, Ankur Gupta2, Ersilia M DeFilippis3, Arman Qamar2, David W Biery2, Zaid Almarzooq2, Bradley Collins2, Amber Fatima4, Candace Jackson5, Patrycja Galazka2, Mattheus Ramsis2, Daniel C Pipilas2, Sanjay Divakaran2, Mary Cawley2, Jon Hainer2, Josh Klein2, Petr Jarolim6, Khurram Nasir7, James L Januzzi8, Marcelo F Di Carli2, Deepak L Bhatt9, Ron Blankstein10. 1. Department of Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: https://twitter.com/AvinainderSingh. 2. Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of Cardiology, Columbia University Medical Center, New York, New York. 4. Department of Medicine, Tufts Medical Center, Boston, Massachusetts. 5. Department of Medicine, Mayo Clinic, Rochester, Minnesota. 6. Department of Pathology and Lab Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 7. Department of Medicine, Yale University School of Medicine, New Haven, Connecticut. 8. Cardiovascular Division, Massachusetts General Hospital, Boston, Massachusetts. 9. Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: https://twitter.com/DLBhattMD. 10. Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: rblankstein@bwh.harvard.edu.
Abstract
BACKGROUND: Type 2 myocardial infarction (MI) and myocardial injury are associated with increased short-term mortality. However, data regarding long-term mortality are lacking. OBJECTIVES: This study compared long-term mortality among young adults with type 1 MI, type 2 MI, or myocardial injury. METHODS: Adults age 50 years or younger who presented with troponin >99th percentile or the International Classification of Diseases code for MI over a 17-year period were identified. All cases were adjudicated as type 1 MI, type 2 MI, or myocardial injury based on the Fourth Universal Definition of MI. Cox proportional hazards models were constructed for survival free from all-cause and cardiovascular death. RESULTS: The cohort consisted of 3,829 patients (median age 44 years; 30% women); 55% had type 1 MI, 32% had type 2 MI, and 13% had myocardial injury. Over a median follow-up of 10.2 years, mortality was highest for myocardial injury (45.6%), followed by type 2 MI (34.2%) and type 1 MI (12%) (p < 0.001). In an adjusted model, type 2 MI was associated with higher all-cause (hazard ratio: 1.8; 95% confidence interval: 1.2 to 2.7; p = 0.004) and cardiovascular mortality (hazard ratio: 2.7; 95% confidence interval: 1.4 to 5.1; p = 0.003) compared with type 1 MI. Those with type 2 MI or myocardial injury were younger and had fewer cardiovascular risk factors but had more noncardiovascular comorbidities. They were significantly less likely to be prescribed cardiovascular medications at discharge. CONCLUSIONS: Young patients who experience a type 2 MI have higher long-term all-cause and cardiovascular mortality than those who experience type 1 MI, with nearly one-half of patients with myocardial injury and more than one-third of patients with type 2 MI dying within 10 years. These findings emphasize the need to provide more aggressive secondary prevention for patients who experience type 2 MI and myocardial injury.
BACKGROUND:Type 2 myocardial infarction (MI) and myocardial injury are associated with increased short-term mortality. However, data regarding long-term mortality are lacking. OBJECTIVES: This study compared long-term mortality among young adults with type 1 MI, type 2 MI, or myocardial injury. METHODS: Adults age 50 years or younger who presented with troponin >99th percentile or the International Classification of Diseases code for MI over a 17-year period were identified. All cases were adjudicated as type 1 MI, type 2 MI, or myocardial injury based on the Fourth Universal Definition of MI. Cox proportional hazards models were constructed for survival free from all-cause and cardiovascular death. RESULTS: The cohort consisted of 3,829 patients (median age 44 years; 30% women); 55% had type 1 MI, 32% had type 2 MI, and 13% had myocardial injury. Over a median follow-up of 10.2 years, mortality was highest for myocardial injury (45.6%), followed by type 2 MI (34.2%) and type 1 MI (12%) (p < 0.001). In an adjusted model, type 2 MI was associated with higher all-cause (hazard ratio: 1.8; 95% confidence interval: 1.2 to 2.7; p = 0.004) and cardiovascular mortality (hazard ratio: 2.7; 95% confidence interval: 1.4 to 5.1; p = 0.003) compared with type 1 MI. Those with type 2 MI or myocardial injury were younger and had fewer cardiovascular risk factors but had more noncardiovascular comorbidities. They were significantly less likely to be prescribed cardiovascular medications at discharge. CONCLUSIONS: Young patients who experience a type 2 MI have higher long-term all-cause and cardiovascular mortality than those who experience type 1 MI, with nearly one-half of patients with myocardial injury and more than one-third of patients with type 2 MI dying within 10 years. These findings emphasize the need to provide more aggressive secondary prevention for patients who experience type 2 MI and myocardial injury.
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