Etiological Classification identified 406 MI events vs. 333 by Binary, capturing 147 additional MI including 44.8% type 2 MIs and distinguishing distinct myocardial injury types.
Does an Etiological Classification of myocardial injury identify a different number and distribution of events compared to a traditional Binary Classification in a community-dwelling cohort?
Applying the Fourth Universal Definition of MI (Etiological Classification) to a prospective cohort identifies significantly more MI events, particularly type 2 MIs, compared to traditional binary classification.
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• Epidemiology of myocardial injury events beyond myocardial infarction (MI) as a binary entity is lacking. • The Universal Definition of MI classifies a spectrum of myocardial injury events based on etiology. • MI is classified by etiology in clinical practice. • Etiological Classification will enable research across the full spectrum of myocardial injury and will allow for the discovery of myocardial injury event type specific precedent risk factors. Prospective cohorts almost exclusively classified acute myocardial injury as a binary entity—presence or absence of myocardial infarction (MI). To compare Binary Classification of MI used in the Multi-Ethnic Study of Atherosclerosis (MESA) to an Etiological Classification of myocardial injury. Comparison of two different MI adjudication systems in 6,809 participants aged 45-84 years old from MESA, a community-dwelling cohort free of cardiovascular disease at enrollment (2000). The Binary Classification defined events as MI versus "No MI". The Etiological Classification, based on the Fourth Universal Definition of MI, categorized events as MI (types 1–5), acute non-ischemic myocardial injury, chronic myocardial injury, and no myocardial injury. Number and distribution of myocardial infarction/injury events identified by each classification system were compared. Binary Classification identified 333 MI events, while Etiological Classification identified 406 MIs, of which 202 (49.8%) were type 1 MI and 182 (44.8%) were type 2 MI, 22 (5.4%) were other MI types. Notably, 147 events (33 type 1 MI, 105 type 2 MI, 9 other MI types) were newly captured as MI with the Etiological Classification that were classified as No-MI by the Binary Classification. Among the 333 MI identified by the Binary Classification, 51% were type 1 MI (N= 169), 23% as type 2 MI (N= 77) and 17% as acute non-ischemic myocardial injury (N= 55) in the Etiological Classification. Etiological Classification identifies additional, etiologically distinct myocardial injury events. Almost half of the events identified as an MI by Binary Classification were identified as type 2 MI or acute non-ischemic myocardial injury by Etiological Classification.
Tomar et al. (Sun,) reported a other. Etiological Classification identified 406 MI events vs. 333 by Binary, capturing 147 additional MI including 44.8% type 2 MIs and distinguishing distinct myocardial injury types.