Key result
Acute myocardial injury links to ~228% higher mortality risk, similar to acute MI.
Why the study?
Patients with acute or chronic myocardial injury are frequently identified during suspected MI evaluations, but their long-term outcomes required investigation.
Does the presence of acute or chronic myocardial injury increase the long-term risk of mortality and cardiovascular events compared to patients without troponin elevation in suspected MI?
Observational (n=2,714)
No
Does the presence of acute or chronic myocardial injury increase the long-term risk of mortality and cardiovascular events compared to patients without troponin elevation in suspected MI?
Hazard Ratio: 3.28 (95% CI 2.09–5.17)
Absolute Event Rate: 81.6% vs 12.2%
p-value: p=<0.001
Patients presenting with acute or chronic myocardial injury have a similarly high long-term risk for death and cardiovascular events as those with acute myocardial infarction, highlighting the need for targeted management strategies.
Myocardial injury signals high all-cause mortality risk; hypothesis-generating for targeted interventions in prospective studies.
AIMS: Patients with acute or chronic myocardial injury are frequently identified in the context of suspected myocardial infarction (MI). We aimed to investigate their long-term follow-up. METHODS AND RESULTS: We prospectively enrolled 2714 patients with suspected MI and followed them for all-cause mortality and a composite cardiovascular endpoint (CVE; cardiovascular death, MI, unplanned revascularization) for a median of 5.1 years. Final diagnoses were adjudicated by two cardiologists according to the Fourth Universal Definition of MI, including 143 (5.3%) ST-elevation MI, 236 (8.7%) non-ST-elevation MI (NSTEMI) Type 1 (T1), 128 (4.7%) NSTEMI T2, 86 (3.2%) acute and 677 (24.9%) with chronic myocardial injury, and 1444 (53.2%) with other reasons for chest pain (reference). Crude event rates per 1000 patient-years for all-cause mortality were highest in patients with myocardial injury (81.6 [71.7, 92.3]), and any type of MI (55.9 [46.3, 66.7]), compared to reference (12.2 [9.8, 15.1]). Upon adjustment, all diagnoses were significantly associated with all-cause mortality. Moreover, patients with acute (adj-HR 1.92 [1.08, 3.43]) or chronic (adj-HR 1.59 [1.16, 2.18]) myocardial injury, and patients with NSTEMI T1 (adj-HR 2.62 [1.85, 3.69]) and ST-elevation MI (adj-HR 3.66 [2.41, 5.57]) were at increased risk for cardiovascular events. CONCLUSION: Patients with myocardial injury are at a similar increased risk for death and cardiovascular events compared to patients with acute MI. Further studies need to determine appropriate management strategies for patients with myocardial injury. REGISTRATION: Clinicaltrials.gov (NCT02355457).
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Haller et al. (2023) conducted an observational in Suspected myocardial infarction (n=2,714). Acute myocardial injury vs. Other reasons for chest pain (no hs-cTn elevation) was evaluated on All-cause mortality (HR 3.28, 95% CI 2.09-5.17, p=<0.001). Acute myocardial injury was associated with a significantly increased risk of all-cause mortality (adj-HR 3.28) compared to patients without troponin elevation, similar to the risk seen in acute myocardial infarction.
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