Anthony Ming-Yu Chuang1,2, Mau T Nguyen1,2, Ehsan Khan1,2, Dylan Jones1,2, Matthew Horsfall1, Sam Lehman1,2, Nathaniel R Smilowitz3, Kristina Lambrakis1,2, Martin Than4, Julian Vaile1,2, Ajay Sinhal1,2, John K French5,6, Derek P Chew1,2. 1. College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia. 2. Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia. 3. Division of Cardiology, Department of Medicine, New York University School of Medicine, New York City, New York, United States of America. 4. Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand. 5. South Western Sydney Clinical School, University of New South Wales, Sydney, Australia. 6. Western Sydney University, Sydney, Australia.
Abstract
BACKGROUND: The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. METHODS: We included all patients presenting to public emergency departments in South Australia between June 2011-Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. RESULTS: 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. CONCLUSIONS: Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.
BACKGROUND: The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. METHODS: We included all patients presenting to public emergency departments in South Australia between June 2011-Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. RESULTS: 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. CONCLUSIONS: Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.
Authors: Kristian Thygesen; Johannes Mair; Evangelos Giannitsis; Christian Mueller; Bertil Lindahl; Stefan Blankenberg; Kurt Huber; Mario Plebani; Luigi M Biasucci; Marco Tubaro; Paul Collinson; Per Venge; Yonathan Hasin; Marcello Galvani; Wolfgang Koenig; Christian Hamm; Joseph S Alpert; Hugo Katus; Allan S Jaffe Journal: Eur Heart J Date: 2012-06-21 Impact factor: 29.983
Authors: Kristian Thygesen; Joseph S Alpert; Allan S Jaffe; Bernard R Chaitman; Jeroen J Bax; David A Morrow; Harvey D White Journal: Circulation Date: 2018-11-13 Impact factor: 29.690
Authors: Tobias Reichlin; Raphael Twerenbold; Miriam Reiter; Stephan Steuer; Stefano Bassetti; Cathrin Balmelli; Katrin Winkler; Sabine Kurz; Claudia Stelzig; Michael Freese; Beatrice Drexler; Philip Haaf; Christa Zellweger; Stefan Osswald; Christian Mueller Journal: Am J Med Date: 2012-12 Impact factor: 4.965
Authors: Ian G Webb; S T Yam; Russel Cooke; Andrew Aitken; Peter D Larsen; Scott A Harding Journal: Heart Lung Circ Date: 2014-08-05 Impact factor: 2.975
Authors: Cynthia Papendick; Andrew Blyth; Anil Seshadri; Michael J R Edmonds; Tom Briffa; Louise Cullen; Stephen Quinn; Jon Karnon; Anthony Chuang; Adam J Nelson; Matthew Horsfall; Erin Morton; Derek P Chew Journal: Am Heart J Date: 2017-05-18 Impact factor: 4.749
Authors: Anoop S V Shah; David A McAllister; Rosamund Mills; Kuan Ken Lee; Antonia M D Churchhouse; Kathryn M Fleming; Elizabeth Layden; Atul Anand; Omar Fersia; Nikhil V Joshi; Simon Walker; Allan S Jaffe; Keith A A Fox; David E Newby; Nicholas L Mills Journal: Am J Med Date: 2014-11-28 Impact factor: 4.965
Authors: Hélène Vallet; Alice Breining; Yannick Le Manach; Judith Cohen-Bittan; Anthony Mézière; Mathieu Raux; Marc Verny; Bruno Riou; Frédéric Khiami; Jacques Boddaert Journal: Medicine (Baltimore) Date: 2017-02 Impact factor: 1.889