Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction

Thomas Nestelberger; Jasper Boeddinghaus; Patrick Badertscher; Raphael Twerenbold; Karin Wildi; Dominik Breitenbücher; Zaid Sabti; Christian Puelacher; Maria Rubini Giménez; Nikola Kozhuharov; Ivo Strebel; Lorraine Sazgary; Deborah Schneider; Janina Jann; Jeanne du Fay de Lavallaz; Òscar Miró; F Javier Martin-Sanchez; Beata Morawiec; Damian Kawecki; Piotr Muzyk; Dagmar I Keller; Nicolas Geigy; Stefan Osswald; Tobias Reichlin; Christian Mueller; APACE Investigators

doi:10.1016/j.jacc.2017.07.774

Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction

J Am Coll Cardiol. 2017 Sep 26;70(13):1558-1568. doi: 10.1016/j.jacc.2017.07.774.

Authors

Thomas Nestelberger¹, Jasper Boeddinghaus¹, Patrick Badertscher², Raphael Twerenbold³, Karin Wildi², Dominik Breitenbücher², Zaid Sabti², Christian Puelacher², Maria Rubini Giménez², Nikola Kozhuharov², Ivo Strebel², Lorraine Sazgary², Deborah Schneider⁴, Janina Jann⁴, Jeanne du Fay de Lavallaz², Òscar Miró⁵, F Javier Martin-Sanchez⁶, Beata Morawiec⁷, Damian Kawecki⁷, Piotr Muzyk⁷, Dagmar I Keller⁸, Nicolas Geigy⁹, Stefan Osswald⁴, Tobias Reichlin², Christian Mueller¹⁰; APACE Investigators

Collaborators

APACE Investigators:
Lukas Schumacher, Samyut Shrestha, Dayana Flores, Katharina Rentsch, Beatriz López, M Cecilia Yañez-Palma, Jiri Parenica, Jens Lohrmann, Andreas Buser

Affiliations

¹ Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University Basel, Basel, Switzerland; GREAT Network, Rome, Italy.
² Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy.
³ Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
⁴ Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
⁵ GREAT Network, Rome, Italy; Emergency Department, Hospital Clinic, Barcelona, Spain.
⁶ Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain.
⁷ 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland.
⁸ Emergency Department, University Hospital Zurich, Zurich, Switzerland.
⁹ Emergency Department, Kantonsspital Liestal, Liestal, Switzerland.
¹⁰ Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy. Electronic address: christian.mueller@usb.ch.

PMID: 28935032
DOI: 10.1016/j.jacc.2017.07.774

Abstract

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 (T2MI₂₀₀₇); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI₂₀₁₂).

Results: Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI₂₀₀₇ definition was 2.8% (n = 112). The application of the more liberal T2MI₂₀₁₂ 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 T2MI₂₀₀₇, 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 T2MI₂₀₀₇ (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI_{2012reclassified} vs. T2MI₂₀₀₇ and T1MI: p = 0.03 and 0.01, respectively).

Conclusions: T2MI_{2012reclassified} has a substantially lower event-related mortality rate compared with T2MI₂₀₀₇ and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).

Keywords: diagnosis; high-sensitivity cardiac troponin; type 2 myocardial infarction.

Publication types

Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Cohort Studies
Coronary Artery Disease / complications
Coronary Artery Disease / diagnosis
Coronary Artery Disease / mortality
Female
Humans
Incidence
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Infarction / epidemiology*
Myocardial Infarction / therapy
Prognosis
Survival Rate

Associated data

ClinicalTrials.gov/NCT00470587