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Clinical features and outcomes of patients with type 2 myocardial infarction: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial.
- Source :
-
American heart journal [Am Heart J] 2018 Feb; Vol. 196, pp. 28-35. Date of Electronic Publication: 2017 Oct 16. - Publication Year :
- 2018
-
Abstract
- Background: Type 2 myocardial infarction (MI) is characterized by an imbalance between myocardial blood supply and demand, leading to myocardial ischemia without coronary plaque rupture, but its diagnosis is challenging.<br />Methods: In the TRACER trial, patients with non-ST-segment elevation acute coronary syndromes were included. We aimed to describe provoking factors, cardiac biomarker profiles, treatment patterns, and clinical outcomes of patients with type 2 MIs. MI events during trial follow-up were adjudicated by an independent clinical events classification committee (CEC) and were classified according to the Third Universal Definition of MI. Using available source documents retrieved as part of the CEC process, we performed a retrospective chart abstraction to collect details on the type 2 MIs. Cox regression models were used to explore the association between MI type (type 1 or type 2) and cardiovascular death.<br />Results: Overall, 10.3% (n=1327) of TRACER participants had a total of 1579 adjudicated MIs during a median follow-up of 502 days (25th and 75th percentiles [IQR] 349-667). Of all MIs, 5.2% (n=82) were CEC-adjudicated type 2 MIs, occurring in 76 patients. The incidence of type 2 MI was higher in the first month following randomization, after which the distribution became more scattered. The most frequent potential provoking factors for type 2 MIs were tachyarrhythmias (38.2%), anemia/bleeding (21.1%), hypotension/shock (14.5%), and hypertensive emergencies (11.8%). Overall, 36.3% had a troponin increase >10× the upper limit of normal. Coronary angiography was performed in 22.4% (n=17) of patients during hospitalizations due to type 2 MIs. The hazard of cardiovascular death was numerically higher following type 2 MI (vs. no MI, adj. HR 11.82, 95% CI 5.71-24.46; P<.0001) than that of type 1 MI (vs. no MI, adj. HR 8.90, 95% CI 6.93-11.43; P<.0001).<br />Conclusions: Type 2 MIs were more prevalent in the first month after ACS, were characterized by the presence of triggers and infrequent use of an invasive strategy, and were associated with a high risk of death. Further efforts are needed to better define the role and implications of type 2 MI in both clinical practice and research.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Acute Coronary Syndrome diagnostic imaging
Aged
Coronary Angiography methods
Disease Progression
Double-Blind Method
Electrocardiography methods
Female
Follow-Up Studies
Humans
Internationality
Male
Middle Aged
Myocardial Ischemia diagnostic imaging
Myocardial Ischemia drug therapy
Myocardial Ischemia mortality
Non-ST Elevated Myocardial Infarction diagnostic imaging
Receptors, Thrombin administration & dosage
Risk Assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome
Acute Coronary Syndrome drug therapy
Acute Coronary Syndrome mortality
Non-ST Elevated Myocardial Infarction drug therapy
Non-ST Elevated Myocardial Infarction mortality
Receptors, Thrombin antagonists & inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6744
- Volume :
- 196
- Database :
- MEDLINE
- Journal :
- American heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 29421012
- Full Text :
- https://doi.org/10.1016/j.ahj.2017.10.007