ORC ID , Maiskov V Victor2 ORC ID , Meray A Imad2 ORC ID , Zhanna D Kobalava1 ORC ID , Usha T Parvathy3 ORC ID , Ibrahim Al-Zakwani4
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Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 70-79

Mortality and morbidity associated with type 2 myocardial infarction: A single-center study

Correspondence Address:
Prof. Zhanna D Kobalava
Head of the Department, Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after Prof. V.S. Moiseev, Institute of Medicine, RUDN University Moscow
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ACCJ.ACCJ_30_20

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Background: The incidence of Type 1 (T1) and Type 2 (T2) myocardial infarction (MI) varies according to the definition used. In clinical practice, approximately one third of T2MI underwent coronary angiography. It may be difficult to accurately diagnose this entity based only on clinical evidence of imbalance between oxygen supply and demand without angiographic data. Objective: The objective of this study was to assess the correlation between angiographic and clinical definitions of Type-2 versus Type-1 myocardial infarction (T2MI vs. T1MI) and prognosis. Methods: A total of 450 consecutive patients with a diagnosis of acute MI were prospectively recruited and underwent coronary angiography <24 h after the onset of symptoms. The mean follow-up was 1.9 years. Results: Atherothrombotic events were found in 275 (61.1%) patients, whereas clinical triggers were identified in 244 (54.2%) cases. T2MI was diagnosed in 175 (28.9%) patients. Rates of in-hospital (7.4% vs. 10.6%; P = 0.268) and long-term (16.6% vs. 17.1%; P = 0.886) mortality were comparable between T2MI and T1MI patients. Those with T2MI had a higher cardiac rehospitalization rate during follow-up (33.3% vs. 19.5%; P = 0.030). Reduced left ventricular ejection fraction (LVEF) was associated with increased long-term mortality (odds ratio 5.2; 95% confidence interval: 1.1–23.5; P = 0.030). GRACE score had a comparable predictive power for in-hospital mortality in both T1 and T2MI subtypes, but was poor in predicting all-cause long-term mortality in patients with T2MI (area under the receiver operating curve 0.663 vs. 0.847; P = 0.009). Conclusions: There was a discrepancy between angiographic and clinical definitions of MI types in a substantial proportion of our patient population. Reduced LVEF was a strong predictor for worse outcomes in T2MI patients. The GRACE score predicted in-hospital mortality well, but not long-term mortality in patients with T2MI.

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