Key result
Over an 11-year period, 1-year all-cause mortality and the provision of cardioprotective medications did not improve in patients with type 2 myocardial infarction, despite modest increases in diagnostic procedures.
Why the study?
Patients with type 2 MI are often underdiagnosed and undertreated compared to type 1 MI, but whether this discrepancy has improved over time is uncertain.
Does the management and 1-year all-cause mortality of type 2 myocardial infarction improve over time compared to type 1 myocardial infarction?
Cohort (n=14,833)
Yes
Does the management and 1-year all-cause mortality of type 2 myocardial infarction improve over time compared to type 1 myocardial infarction?
Despite modest increases in diagnostic procedures, the provision of cardioprotective medications and 1-year all-cause mortality did not improve over an 11-year period for patients with type 2 myocardial infarction.
Despite poor prognosis, patients with type 2 myocardial infarction (MI) tend to be underdiagnosed and undertreated compared to those with type 1 MI. Whether this discrepancy has improved over time is uncertain. We conducted a registry-based cohort study investigating type 2 MI patients managed at Swedish coronary care units (n = 14,833) during 2010–2022. Multivariable-adjusted changes (first three vs last three calendar years of the observation period) were assessed regarding diagnostic examinations (echocardiography, coronary assessment), provision of cardioprotective medications (betablockers, renin–angiotensin–aldosterone-system inhibitors, statins) and 1-year all-cause mortality. Compared to type 1 MI patients (n = 184,329), those with type 2 MI less often had diagnostic examinations and cardioprotective medications. Increases in the use of echocardiography (OR 1.08 [95% confidence interval 1.06–1.09]) and coronary assessment (OR 1.06 [95% confidence interval 1.04–1.08]) were smaller compared to type 1 MI (p interaction < 0.001). The provision of medications did not increase in type 2 MI. All-cause mortality rate in type 2 MI was 25.4% without temporal change (OR 1.03 [95% confidence interval 0.98–1.07]). Taken together, the provision of medications and all-cause mortality did ot improve in type 2 MI despite modest increases in diagnostic procedures. This emphasizes the need of defining optimal care pathways in these patients.
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Eggers et al. (2023) conducted a cohort in Type 2 myocardial infarction (n=14,833). Later admission period (2019-2021) vs. Early admission period (2010-2012) was evaluated on 1-year all-cause mortality (OR 1.00, 95% CI 0.97-1.03, p=0.992). Over an 11-year period, 1-year all-cause mortality and the provision of cardioprotective medications did not improve in patients with type 2 myocardial infarction, despite modest increases in diagnostic procedures.
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