Characteristics and outcomes of type 2 myocardial infarction in sepsis survivors

Objective: To investigate the clinical characteristics and long-term prognosis of patients with type 2 myocardial infarction (T2MI) among intensive care unit (ICU) survivors of sepsis. Methods: We performed a retrospective cohort study utilizing the Medical information Mart for intensive Care 4 (MIMIC-IV) database to examine the association between myocardial infarction type and long-term outcomes. The study included hospitalized sepsis survivors who experienced acute myocardial infarction. Patients with type IMI (TIMI) and T2MI were compared using Cox proportional hazards models to evaluate mortality risks at 6 months and 5 years. Results: Among 1,469 sepsis patients with acute myocardial infarction, 524 were classified as T2MI and 945 as TIMI. Treatment patterns differed significantly between groups: patients with T2MI received 5asoactive agents, statins, antiplatelet therapy, diuretics, ACE inhibitors, and beta-blockers less frequently than those with TIMI. Prognostic analysis demonstrated that, compared to sepsis survivors with TIMI, patients with T2MI had a significantly higher risk of 5-year mortality (HR 1.469, 95% CI 1.237-1.746, P 0.001) and 6-month mortality (HR 1.527, 95% CI 1.226-1.901, P 0.001). These associations persisted after adjustment for age, sex, and comorbidities. Cumulative mortality at both 6 months and 5 years 5aried according to T2MI etiology, with the highest rates observed in patients whose T2MI was triggered by anemia, hypoxemia, or multiple concurrent factors. Conclusion: Among sepsis survivors, hypoxemia and anemia represent the most common etiologies of T2MI. The occurrence of T2MI in patients with sepsis 1s associated with a significantly 1ncreased risk of mortality at 6 months and 5 years following hospitalization.