Cardiovascular Risk Across Myocardial Injury and Infarction Categories Using the Universal Definition
Key result
Type 1 and 2 MI linked to up to ~382% greater MACE risk versus no injury.
- HR 4.82
- 95% CI 3.55-6.57
- n=120,734
Why the study?
The Universal Definition classifies myocardial infarction by etiology, but its prognostic implications remain uncertain.
Population
120,734 patients evaluated for suspected acute coronary syndrome across 17 prospective studies
Comparison
Type 1 MI, type 2 MI, acute myocardial injury, and chronic myocardial injury vs no myocardial injury
Design
Systematic review and meta-analysis of prospective studies
Follow-up
Minimum of 1 year
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“What we demonstrate is that even if you a type 2 myocardial infarction secondary to another illness you are still at an increased risk of a future cardiovascular event, be that a future MI or death from a cardiac cause. And at the moment, these patients are treated in a very, very different way to patients with type 1 myocardial infarction.”
“That's where I think we need a better understanding of what's causing the injury, and we will have to have more refined understanding to be able to target a treatment to that group because it's such a heterogeneous group.”
Implication
Systematic review and meta-analysis reveals elevated cardiovascular risk across all myocardial injury classes, highlighting substantial competing noncardiovascular mortality in type 2 infarction.
Key Points
- To evaluate and compare the long-term rates and risks of recurrent myocardial infarction or cardiovascular death across Universal Definition categories of myocardial injury and infarction.
- Systematic review and meta-analysis of 17 prospective studies from 9 cohorts across 9 countries (N=120,734; median age 61.0 years, 45.8% women) evaluating patients with suspected acute coronary syndrome.
- Eligible studies adjudicated diagnoses using the Universal Definition and reported cause-specific mortality and myocardial infarction with at least 1 year of follow-up.
- Random-effects meta-analyses calculated subdistribution hazard ratios to account for the competing risk of noncardiovascular death for the primary outcome of MACE (myocardial infarction or cardiovascular death).
- MACE risk was highest in type 1 MI (sHR 4.82, 95% CI: 3.55-6.57; rate 55.2 per 1,000 patient-years) followed by type 2 MI (sHR 3.36, 95% CI: 2.92-3.86; rate 51.7 per 1,000 patient-years) compared with no myocardial injury.
- Patients with acute and chronic myocardial injury also experienced increased MACE risk (sHR 3.24, 95% CI: 2.41-4.36; rate 47.1 per 1,000 patient-years and sHR 3.03, 95% CI: 2.53-3.62; rate 44.9 per 1,000 patient-years, respectively).
- Noncardiovascular death rates were markedly higher in type 2 MI (60.1 per 1,000 patient-years) and acute myocardial injury (67.0 per 1,000 patient-years) compared to type 1 MI (25.7 per 1,000 patient-years).
Study Design
Type
Meta-Analysis (n=120,734)
Multicenter
Yes
PICO
P
Population
120,734 patients with suspected acute coronary syndrome from 9 cohorts, with a median age of 61.0 years and 45.8% women, followed for at least 1 year.
E
Exposure / Comparator
Myocardial injury and infarction (Universal Definition) vs No myocardial injury
O
Primary Outcome
Major adverse cardiovascular events (MACE), defined as MI or cardiovascular death — HR 4.82 (3.55-6.57)
Main Result
Hazard Ratio: 4.82 (95% CI 3.55–6.57)
Cite This Study
Boeddinghaus et al. (2025) conducted a meta-analysis in Suspected acute coronary syndrome (n=120,734). Myocardial injury and infarction (Universal Definition) vs. No myocardial injury was evaluated on Major adverse cardiovascular events (MACE), defined as MI or cardiovascular death (HR 4.82, 95% CI 3.55-6.57). Compared with no myocardial injury, type 1 MI (HR 4.82; 95% CI 3.55-6.57) and type 2 MI (HR 3.36; 95% CI 2.92-3.86) were associated with a significantly increased risk of MACE.