Cardiologist Evaluation of Patients With Type 2 Myocardial Infarction

T ype 2 myocardial infarction (MI) is caused by supply/demand mismatch (rather than plaque rupture).Treatment is typically directed at correcting the precipitant of mismatch.Notably, patients with type 2 MI have high rates of recurrent events and may deserve tailored management.1,2 How often patients are evaluated by a cardiologist during hospitalization and the association between these evaluations and diagnostic testing and treatments is uncertain.Furthermore, it is unknown how frequently patients with type 2 MI receive cardiology follow-up after discharge.The data that support the findings of this study may be available from the corresponding author upon reasonable request.We identified patients coded with a type 2 MI (International Classification of Diseases Tenth Revision code I21.A1) from our electronic health record at Massachusetts General Hospital between October 2017 and May 2018.Six physicians reviewed patients chart (including ECG, echocardiogram, stress testing, and coronary angiography) and applied the fourth Universal Definition of MI criteria to adjudicate the diagnosis as previously described.3 Uncertain cases were reviewed by one physician (C.P. McCarthy) for consistency.A cardiologist evaluation was defined as either an admission (or transfer) to a cardiology service or a cardiology consultation.Baseline characteristics, diagnostic testing performed, and discharge medications were obtained by physician chart review and compared using χ 2 or Fisher exact tests for dichotomous variables and Welch 2 sample t-tests for continuous variables.This study was approved by the Partners Healthcare Institutional Review Board; informed consent was waived.We identified 359 patients with type 2 MI.Of those, 207 (57.7%) were evaluated by a cardiologist; 120 (33.4%) received a cardiology consultation, and 87 (24.2%) were admitted (or transferred) to a cardiology service.Patients evaluated by a cardiologist had more cardiovascular risk factors and were more commonly on aspirin before admission (Table ).Patients evaluated by cardiologists had more regional wall motion abnormalities on their transthoracic echocardiogram (33.8% versus 11.2%; P<0.001) at the time of diagnosis of their type 2 MI; however, there was no difference in clinical presentation, including similar rates of chest pain (24.6% versus 34.9%; P=0.82), shortness of breath (34.3% versus 34.9%; P=1.00), ST-segment changes (41.5% versus 36.2%;P=0.36), or ischemic T wave abnormalities (41.5% versus 50%; P=0.14), respectively.Patients evaluated by a cardiologist more commonly underwent stress testing (13.5% versus 3.3%, P=0.002; adjusted odds ratio: 4.91 [95% CI, 1.95-15.05]),transthoracic echocardiography (80.2% versus 50.7%;P<0.001; adjusted odds ratio: 4.68 [95% CI, 2.86-7.79]),and coronary angiography (21.3% versus 0%; P<0.001) during index admission.There was no difference in all-cause mortality