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.
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?
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.
Hazard Ratio: 3.28 (95% CI 2.09–5.17)
Absolute Event Rate: 81.6% vs 12.2%
p-value: p=<0.001
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).
Haller et al. (Mon,) conducted a 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.