Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 70, Issue 13, Pages 1558-1568Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2017.07.774
Keywords
diagnosis; high-sensitivity cardiac troponin; type 2 myocardial infarction
Categories
Funding
- Swiss National Science Foundation
- Swiss Heart Foundation
- European Union
- Cardiovascular Research Foundation Basel
- University Hospital Basel
- Abbott
- Brahms
- Beckman Coulter
- Biomerieux
- Roche
- Nanosphere
- Siemens
- 8sense
- Buhlmann
- Singulex
- Swiss National Science Foundation [P300PB-167803/1, PASMP3-136995]
- Goldschmidt-Jacobson-Foundation
- Professor Max Cloetta Foundation
- Uniscientia Foundation Vaduz
- University of Basel
- Department of Internal Medicine
- Department of Internal Medicine, University Hospital Basel
- KTI
- Stiftung fur kardiovaskulare Forschung Basel
- Alere
- AstraZeneca
- Sphingotec
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BACKGROUND Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice. OBJECTIVES This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need. METHODS The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI(2007)); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI(2012)). RESULTS Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI(2007) definition was 2.8% (n = 112). The application of the more liberal T2MI(2012) definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI(2012reclassified)). Among T2MI(2007), 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI(2012reclassified) patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI(2012reclassified), which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI(2007) (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI(2012reclassified) vs. T2MI(2007) and T1MI: p = 0.03 and 0.01, respectively). CONCLUSIONS T2MI(2012reclassified) has a substantially lower event-related mortality rate compared with T2MI(2007) and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587) (C) 2017 by the American College of Cardiology Foundation.
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