Treatment and outcomes of type 2 myocardial infarction and myocardial injury compared with type 1 myocardial infarction
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Key result
Type 2 myocardial infarction and myocardial injury were associated with similar all-cause mortality compared to type 1 myocardial infarction (30.8%, 29.7%, and 29.9% respectively; p=0.94) over a median 1.8 years.
Why the study?
Does all-cause mortality differ between patients with type 2 MI or myocardial injury compared to type 1 MI?
Population
458 patients admitted to a Veterans Affairs tertiary care hospital with a rise and fall in cardiac troponin
Comparison
Type 2 myocardial infarction or myocardial injury vs Type 1 myocardial infarction
Design
Cohort
Follow-up
median 1.8 years
Authors
Discussion
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Implication
Similar mortality across subtypes supports uniform post-discharge monitoring; extends classification utility beyond observational cohorts.
Key Points
- The aim is to compare the clinical characteristics, management, and outcomes of type 2 myocardial infarction and myocardial injury to type 1 myocardial infarction.
- Identified patients admitted to a Veterans Affairs tertiary care hospital with a rise and fall in cardiac troponin.
- Determined subtypes of myocardial infarction and injury, their presentation, management, and outcomes.
- Followed patients for a median of 1.8 years.
- Type 1 MI occurred in 137, type 2 MI in 146, and myocardial injury in 175 patients.
- Type 2 MI patients were older (P=0.02), had lower peak cardiac troponin (P<0.001), and were less likely to receive aspirin and statin at discharge (P<0.001).
- All-cause mortality was similar across groups (type 1 MI: 29.9%, type 2 MI: 30.8%, myocardial injury: 29.7%; log rank P=0.94).
Study Design
Type
Cohort (n=458)
Multicenter
No
Structured PICO
Does all-cause mortality differ between patients with type 2 MI or myocardial injury compared to type 1 MI?
P
Population
458 predominantly male veterans with abnormal cardiac troponin levels classified as type 1 MI, type 2 MI, or myocardial injury, followed for a median of 1.8 years.
E
Exposure
Type 2 myocardial infarction or myocardial injury
C
Comparator
Type 1 myocardial infarction
O
Outcome
All-cause mortalityhard clinical
Main Result
Absolute Event Rate: 30.8% vs 29.9%
p-value: p=0.94
Patients with type 2 MI and myocardial injury have similar all-cause mortality to those with type 1 MI but are significantly less likely to receive guideline-directed medical therapy for CAD.
Limitations
- Potential misclassification bias regarding distinctions between type 2 MI, myocardial injury, and non-specific troponin elevations
- Relatively small sample size from a single center
- Few women included due to the veteran population demographics
- Lack of data from non-VA facilities on re-hospitalization or subsequent cardiovascular testing
Cite This Study
Smilowitz et al. (2017) conducted a cohort in Myocardial Infarction and Myocardial Injury (n=458). Type 2 myocardial infarction or myocardial injury vs. Type 1 myocardial infarction was evaluated on All-cause mortality (p=0.94). Type 2 myocardial infarction and myocardial injury were associated with similar all-cause mortality compared to type 1 myocardial infarction (30.8%, 29.7%, and 29.9% respectively; p=0.94) over a median 1.8 years.
Topics
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