Nathaniel R Smilowitz1,2, Binita Shah1,2, Jeffrey Lorin1,2, Jeffrey S Berger1,3. 1. Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine. 2. Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System. 3. Department of Surgery, New York University School of Medicine, New York, USA.
Abstract
BACKGROUND: Type 2 myocardial infarction (MI) occurs due to a mismatch in myocardial oxygen supply and demand without unstable coronary artery disease. We sought to identify patterns, predictors and outcomes of invasive management of type 2 MI in the USA. METHODS: Adults aged ≥18 years hospitalized with type 2 MI were identified in a cross-sectional study from the 2018 National Inpatient Sample. Invasive management was defined as invasive coronary angiography or revascularization. Patient, hospital and geographic characteristics associated with invasive management were identified by multivariable logistic regression. Propensity-matched cohorts were generated to evaluate associations between invasive vs. conservative management and mortality. RESULTS: We identified 268 850 admissions with type 2 MI in 2018. Type 2 MI patients had a high burden of comorbidities and were commonly admitted with diagnoses of circulatory (39.7%), infectious (23.1%) or respiratory (10.8%) illness. Only 11.2% of type 2 MI were managed invasively, of which 17.9% underwent coronary revascularization. Odds of invasive management were higher with commercial insurance [adjusted OR (aOR) 1.39; 95% confidence interval (CI), 1.27-1.52] and lower with Medicaid (aOR 0.86; 95% CI, 0.76-0.96) vs. Medicare. Significant heterogeneity in invasive management of type 2 MI was observed by geographic region (range 7.2-13.8%), independent of patient and hospital factors. Invasive management was associated with lower in-hospital mortality than conservative management overall (3.9 vs. 9.1%; P < 0.001) and in propensity-matched analyses (OR, 0.70; 95% CI, 0.59-0.84). CONCLUSION: Invasive management of type 2 MI varies by insurance status and geography, highlighting uncertainty regarding optimal management and potential disparities in clinical care.
BACKGROUND: Type 2 myocardial infarction (MI) occurs due to a mismatch in myocardial oxygen supply and demand without unstable coronary artery disease. We sought to identify patterns, predictors and outcomes of invasive management of type 2 MI in the USA. METHODS: Adults aged ≥18 years hospitalized with type 2 MI were identified in a cross-sectional study from the 2018 National Inpatient Sample. Invasive management was defined as invasive coronary angiography or revascularization. Patient, hospital and geographic characteristics associated with invasive management were identified by multivariable logistic regression. Propensity-matched cohorts were generated to evaluate associations between invasive vs. conservative management and mortality. RESULTS: We identified 268 850 admissions with type 2 MI in 2018. Type 2 MI patients had a high burden of comorbidities and were commonly admitted with diagnoses of circulatory (39.7%), infectious (23.1%) or respiratory (10.8%) illness. Only 11.2% of type 2 MI were managed invasively, of which 17.9% underwent coronary revascularization. Odds of invasive management were higher with commercial insurance [adjusted OR (aOR) 1.39; 95% confidence interval (CI), 1.27-1.52] and lower with Medicaid (aOR 0.86; 95% CI, 0.76-0.96) vs. Medicare. Significant heterogeneity in invasive management of type 2 MI was observed by geographic region (range 7.2-13.8%), independent of patient and hospital factors. Invasive management was associated with lower in-hospital mortality than conservative management overall (3.9 vs. 9.1%; P < 0.001) and in propensity-matched analyses (OR, 0.70; 95% CI, 0.59-0.84). CONCLUSION: Invasive management of type 2 MI varies by insurance status and geography, highlighting uncertainty regarding optimal management and potential disparities in clinical care.
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Authors: Fernando Botto; Pablo Alonso-Coello; Matthew T V Chan; Juan Carlos Villar; Denis Xavier; Sadeesh Srinathan; Gordon Guyatt; Patricia Cruz; Michelle Graham; C Y Wang; Otavio Berwanger; Rupert M Pearse; Bruce M Biccard; Valsa Abraham; German Malaga; Graham S Hillis; Reitze N Rodseth; Deborah Cook; Carisi A Polanczyk; Wojciech Szczeklik; Daniel I Sessler; Tej Sheth; Gareth L Ackland; Martin Leuwer; Amit X Garg; Yannick Lemanach; Shirley Pettit; Diane Heels-Ansdell; Giovanna Luratibuse; Michael Walsh; Robert Sapsford; Holger J Schünemann; Andrea Kurz; Sabu Thomas; Marko Mrkobrada; Lehana Thabane; Hertzel Gerstein; Pilar Paniagua; Peter Nagele; Parminder Raina; Salim Yusuf; P J Devereaux; P J Devereaux; Daniel I Sessler; Michael Walsh; Gordon Guyatt; Matthew J McQueen; Mohit Bhandari; Deborah Cook; Jackie Bosch; Norman Buckley; Salim Yusuf; Clara K Chow; Graham S Hillis; Richard Halliwell; Stephen Li; Vincent W Lee; John Mooney; Carisi A Polanczyk; Mariana V Furtado; Otavio Berwanger; Erica Suzumura; Eliana Santucci; Katia Leite; Jose Amalth do Espirirto Santo; Cesar A P Jardim; Alexandre Biasi Cavalcanti; Helio Penna Guimaraes; Michael J Jacka; Michelle Graham; Finlay McAlister; Sean McMurtry; Derek Townsend; Neesh Pannu; Sean Bagshaw; Amal Bessissow; Mohit Bhandari; Emmanuelle Duceppe; John Eikelboom; Javier Ganame; James Hankinson; Stephen Hill; Sanjit Jolly; Andre Lamy; Elizabeth Ling; Patrick Magloire; Guillaume Pare; Deven Reddy; David Szalay; Jacques Tittley; Jeff Weitz; Richard Whitlock; Saeed Darvish-Kazim; Justin Debeer; Peter Kavsak; Clive Kearon; Richard Mizera; Martin O'Donnell; Matthew McQueen; Jehonathan Pinthus; Sebastian Ribas; Marko Simunovic; Vikas Tandon; Tomas Vanhelder; Mitchell Winemaker; Hertzel Gerstein; Sarah McDonald; Paul O'Bryne; Ameen Patel; James Paul; Zubin Punthakee; Karen Raymer; Omid Salehian; Fred Spencer; Stephen Walter; Andrew Worster; Anthony Adili; Catherine Clase; Deborah Cook; Mark Crowther; James Douketis; Azim Gangji; Paul Jackson; Wendy Lim; Peter Lovrics; Sergio Mazzadi; William Orovan; Jill Rudkowski; Mark Soth; Maria Tiboni; Rey Acedillo; Amit Garg; Ainslie Hildebrand; Ngan Lam; Danielle Macneil; Marko Mrkobrada; Pavel S Roshanov; Sadeesh K Srinathan; Clare Ramsey; Philip St John; Laurel Thorlacius; Faisal S Siddiqui; Hilary P Grocott; Andrew McKay; Trevor W R Lee; Ryan Amadeo; Duane Funk; Heather McDonald; James Zacharias; Juan Carlos Villar; Olga Lucía Cortés; Maria Stella Chaparro; Skarlett Vásquez; Alvaro Castañeda; Silvia Ferreira; Pierre Coriat; Denis Monneret; Jean Pierre Goarin; Cristina Ibanez Esteve; Catherine Royer; Georges Daas; Matthew T V Chan; Gordon Y S Choi; Tony Gin; Lydia C W Lit; Denis Xavier; Alben Sigamani; Atiya Faruqui; Radhika Dhanpal; Smitha Almeida; Joseph Cherian; Sultana Furruqh; Valsa Abraham; Lalita Afzal; Preetha George; Shaveta Mala; Holger Schünemann; Paola Muti; Enrico Vizza; C Y Wang; G S Y Ong; Marzida Mansor; Alvin S B Tan; Ina I Shariffuddin; V Vasanthan; N H M Hashim; A Wahab Undok; Ushananthini Ki; Hou Yee Lai; Wan Azman Ahmad; Azad H A Razack; German Malaga; Vanessa Valderrama-Victoria; Javier D Loza-Herrera; Maria De Los Angeles Lazo; Aida Rotta-Rotta; Wojciech Szczeklik; Barbara Sokolowska; Jacek Musial; Jacek Gorka; Pawel Iwaszczuk; Mateusz Kozka; Maciej Chwala; Marcin Raczek; Tomasz Mrowiecki; Bogusz Kaczmarek; Bruce Biccard; Hussein Cassimjee; Dean Gopalan; Theroshnie Kisten; Aine Mugabi; Prebashini Naidoo; Rubeshan Naidoo; Reitze Rodseth; David Skinner; Alex Torborg; Pilar Paniagua; Gerard Urrutia; Mari Luz Maestre; Miquel Santaló; Raúl Gonzalez; Adrià Font; Cecilia Martínez; Xavier Pelaez; Marta De Antonio; Jose Marcial Villamor; Jesús Alvarez García; Maria José Ferré; Ekaterina Popova; Pablo Alonso-Coello; Ignacio Garutti; Patricia Cruz; Carmen Fernández; Maria Palencia; Susana Díaz; Teresa Del Castillo; Alberto Varela; Angeles de Miguel; Manuel Muñoz; Patricia Piñeiro; Gabriel Cusati; Maria Del Barrio; Maria José Membrillo; David Orozco; Fidel Reyes; Robert J Sapsford; Julian Barth; Julian Scott; Alistair Hall; Simon Howell; Michaela Lobley; Janet Woods; Susannah Howard; Joanne Fletcher; Nikki Dewhirst; C Williams; A Rushton; I Welters; M Leuwer; Rupert Pearse; Gareth Ackland; Ahsun Khan; Edyta Niebrzegowska; Sally Benton; Andrew Wragg; Andrew Archbold; Amanda Smith; Eleanor McAlees; Cheryl Ramballi; Neil Macdonald; Marta Januszewska; Robert Stephens; Anna Reyes; Laura Gallego Paredes; Pervez Sultan; David Cain; John Whittle; Ana Gutierrez Del Arroyo; Daniel I Sessler; Andrea Kurz; Zhuo Sun; Patrick S Finnegan; Cameron Egan; Hooman Honar; Aram Shahinyan; Krit Panjasawatwong; Alexander Y Fu; Sihe Wang; Edmunds Reineks; Peter Nagele; Jane Blood; Megan Kalin; David Gibson; Troy Wildes Journal: Anesthesiology Date: 2014-03 Impact factor: 7.892