TYPE 2 MYOCARDIAL INFARCTION: CLINICAL AND DEMOGRAPHIC FEATURES, LABORATORY AND INSTRUMENTAL ASSOCIATIONS
- Authors: Hoang HT1, Kitbalyan AA2, Lazarev PV1, Maiskov VV1,3, Shkolinikova EE1, Meray IA1
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Affiliations:
- Peoples’ Friendship University of Russia (RUDN University)
- Moscow State University
- Vinogradov Clinical Hospital No. 64
- Issue: Vol 22, No 2 (2018)
- Pages: 148-158
- Section: CARDIOLOGY
- URL: https://journals.rudn.ru/medicine/article/view/18952
- DOI: https://doi.org/10.22363/2313-0245-2018-22-2-148-158
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Abstract
Background: Type 2 (T2) myocardial infarction (MI) is diagnosed in patients with acute coronary syndrome with increasing frequency. However, the information on etiology, pathogenetic mechanisms, instrumental and laboratory features is inconsistent. Purpose: to examine the clinical and demographic parameters, and results of routinely performed laboratory and instrumental test in patients with T2 MI and compare them with population characteristics of type 1 (T1) MI. Methods: We retrospectively included 450 consecutive patients admitted with acute MI diagnosed in accordance with the Third Universal Definition (2012) that underwent coronary angiography. T1 MI was diagnosed in the presence of intraluminal thrombus in the epicardial vessel, or absence of atherosclerotic plaque integrity with decreased myocardial blood flow (TIMI < 3). All other patients were classified as having T2 MI. We analyzed electronic medical records to obtain their data. Student’s t-test and chi-square methods were used to compare single variables in patients with T1 and T2 MI. Multiple logistic regression was then performed to establish independent association of studied parameters with the type of MI. Results: Type 2 MI was diagnosed in 175 (39%) patients and was associated with increasing age (p = 0.007) and female gender (p = 0.01). T2 MI patients more frequently present without ST segment elevation (p = 0.001) and have lower troponin values (p = 0.001). They also had more often had a previous MI (p < 0.001) and had undergone myocardial revascularisation (p = 0.002). The absence of obstructive coronary atherosclerosis was diagnosed in a small fraction of patients with T2 MI [12 (6.9%)]. Independent predictors of having T2 MI were the presence of anemia (p < 0.001), left bundle branch block (p = 0.019), the absence of ST-segment elevation (p = 0.001), age ≥ 70 years (p = 0.014) and the absence of local wall motion abnormalilties on echocardiography (p = 0.002). Conclusion: Type 2 myocardial infarction is diagnosed in a substantial proportion of MI patients and is independently associated with concomitant anemia, left bundle branch block, absence of ST-segment elevation, older age, and the echocardiographic absence of local hypo- and akinesia of the left ventricle.
About the authors
H T Hoang
Peoples’ Friendship University of Russia (RUDN University)
Author for correspondence.
Email: lazarev@pfur.ru
A A Kitbalyan
Moscow State University
Email: lazarev@pfur.ru
P V Lazarev
Peoples’ Friendship University of Russia (RUDN University)
Email: lazarev@pfur.ru
PhD, assistant of Department of internal diseases, Medical Institute Peoples’ Friendship University of Russia
V V Maiskov
Peoples’ Friendship University of Russia (RUDN University); Vinogradov Clinical Hospital No. 64
Email: lazarev@pfur.ru
E E Shkolinikova
Peoples’ Friendship University of Russia (RUDN University)
Email: lazarev@pfur.ru
I A Meray
Peoples’ Friendship University of Russia (RUDN University)
Email: lazarev@pfur.ru
References
- Thygesen K. et al. Third universal definition of myocardial infarction. Circulation. 2012. Vol. 126. № 16. P. 2020—2035.
- Baron T. et al. Type 2 myocardial infarction in clinical practice. Heart. 2015. Vol. 101. № 2. P. 101—106.
- Saaby L. et al. Mortality rate in type 2 myocardial infarction: Observations from an unselected hospital cohort. Am. J. Med. Elsevier Inc, 2014. Vol. 127. № 4. P. 295—302.
- Sandoval Y. et al. Supply/Demand Type 2 Myocardial Infarction. J. Am. Coll. Cardiol. 2014. Vol. 63. № 20. P. 2079—2087.
- Stein G.Y. et al. Type-II myocardial infarction — Patient characteristics, management and outcomes. PLoS One. 2014. Vol. 9. № 1. P. 1—6.
- Kuznetsova O.Yu. et al. The classification of acute myocardial infarction types and the preconditions for its development. Type II myocardial infarction. Russian family doctor. 2017. Vol. 21. No. 3. P. 5—15. (In Russ.).
- Saaby L. et al. Classification of myocardial infarction: Frequency and features of type 2 myocardial infarction. Am. J. Med. Elsevier Inc, 2013. Vol. 126. № 9. P. 789—797.
- Sarkisian L. et al. Clinical Characteristics and Outcomes of Patients with Myocardial Infarction, Myocardial Injury, and Nonelevated Troponins. Am. J. Med. Elsevier Inc, 2016. Vol. 129. № 4. P. 446.e5—446.e21.
- Cediel G. et al. Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury. Heart. 2017. Vol. 103. № 8. P. 616—622.
- López-Cuenca A. et al. Comparison between type-2 and type-1 myocardial infarction: Clinical features, treatment strategies and outcomes. J. Geriatr. Cardiol. 2016. Vol. 13. № 1. P. 15—22.
- Stein G.Y. et al. Type-II myocardial infarction-patient characteristics, management and outcomes. PLoS One. 2014. Vol. 9. № 1. P. e84285.
- Javed U. et al. Frequency of Elevated Troponin I and Diagnosis of Acute Myocardial Infarction. Am. J. Cardiol. Elsevier Inc., 2009. Vol. 104. № 1. P. 9—13.
- Januzzi J.L. et al. The Many Faces of Type 2 Myocardial Infarction. J. Am. Coll. Cardiol. 2017. Vol. 70. № 13. P. 1569—1572.
- Zharsky S. L. Type 2 myocardial infarction: Solved and unsolved issues. Heart: journal for practitioners. 2016. Vol. 92. No. (6). P. 404—409. (In Russ.).
- McCarthy C.P. et al. Type 2 Myocardial Infarction — An Evolving Entity. Circ. J. 2018.
- Alpert J.S. et al. Diagnostic and Therapeutic Implications of Type 2 Myocardial Infarction: Review and Commentary. Am. J. Med. Elsevier Inc, 2014. Vol. 127. № 2. P. 105—108.
- Smilowitz N.R. et al. Diagnosis and Management of Type II Myocardial Infarction: Increased Demand for a Limited Supply of Evidence. Curr. Atheroscler. Rep. 2015. Vol. 17. № 2. P. 1—7.
- Anderson J.L. et al. Acute Myocardial Infarction. N. Engl. J. Med. 2017. Vol. 376. № 21. P. 2053—2064.
- Tweet M.S. et al. Unique Presentations and Etiologies of Myocardial Infarction in Women. Curr. Treat. Options Cardiovasc. Med. Current Treatment Options in Cardiovascular Medicine, 2017. Vol. 19. № 9.
- Hanson I. et al. Angiographic and clinical characteristics of type 1 versus type 2 perioperative myocardial infarction. Catheter. Cardiovasc. Interv. 2013. Vol. 82. № 4. P. 622—628.
- Baron T. et al. Impact on Long-Term Mortality of Presence of Obstructive Coronary Artery Disease and Classification of Myocardial Infarction. Am. J. Med. 2016. Vol. 129. № 4. P. 398—406.
- Matsue Y. et al. Clinical Features and Prognosis of Type 2 Myocardial Infarction in Vasospastic Angina. Am. J. Med. Elsevier Inc, 2015. Vol. 128. № 4. P. 389—395.
- Smilowitz N.R. et al. Provoking conditions, management and outcomes of type 2 myocardial infarction and myocardial necrosis. Int. J. Cardiol. Elsevier B.V., 2016. Vol. 218. P. 196—201.
- Chapman A.R. et al. Refining the Diagnosis of Type 2 Myocardial Infarction. JAMA Cardiol. 2017. Vol. 2. № 1. P. 106.
- Nestelberger T. et al. Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction. J. Am. Coll. Cardiol. 2017. Vol. 70. № 13. P. 1558—1568.
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