КЛИНИКО-ДЕМОГРАФИЧЕСКИЕ ХАРАКТЕРИСТИКИ, РАСПРОСТРАНЕННОСТЬ ФАКТОРОВ РИСКА И СОПУТСТВУЮЩИХ ЗАБОЛЕВАНИЙ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА 2-ГО ТИПА

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 2) и t-критерий Стьюдента. Для выявления взаимосвязи отдельных параметров с типом ИМ использовались процедуры однофакторного и многофакторного логистического регрессионного анализа. Результаты: ИМ2Т был диагностирован у 175 (38,9%) пациентов с преобладанием среди них лиц старшего возраста (р = 0,007) и женского пола (р = 0,01). При ИМ2Т реже регистрировался подъем сегмента ST (р = 0,001) и отмечались более низкие значения тропонина (р = 0,001). Пациенты с ИМ2Т чаще имели анамнез ранее перенесенного ИМ (р 0,05). Независимыми предикторами ИМ2Т были наличие анемии (р < 0,001), блокада левой ножки пучка Гиса (р = 0,019), отсутствие подъема сегмента ST на ЭКГ (р = 0,001), возраст ≥ 70 лет (р = 0,014) и нарушений локального сократимости при эхокардиографии (р = 0,002). Заключение: Инфаркт миокарда 2-го типа выявляется у значительной части пациентов с ИМ и независимо ассоциирован с пожилым возрастом, сопутствующей анемией, блокадой левой ножки пучка Гиса, отсутствием подъема ST на ЭКГ, нормальной сократимостью левого желудочка по данным эхокардиографии

Development and validation of a model for predicting 18-month mortality in type 2 myocardial infarction

Background: Despite the poor prognosis in patients with type 2 myocardial infarction (MI), no prospective data on risk stratification exists. The aim of this study was to develop and validate a model for prediction of 18-month mortality of among patients with type 2 MI (T2MI) and compare its performance with GRACE and TARRACO scores. Methods: The prospective observational study included 712 consecutive patients diagnosed with MI undergoing coronary angiography <24 h between January 2017 and December 2018. Diagnosis of T2MI was adjusted according to Third universal definition. A prognostic model was developed by using Bayesian approach and logistic regression analysis with identifying predictors for mortality. The model was validated by bootstrap validation. Comparison performance between scores using Delong test. Results: T2MI was identified in 174 (24.4%) patients. The median age of patients was 69 years, 52% were female. The mortality rate was 20.1% at 18 months. Prior MI, presence of ST elevation, hemoglobin level at admission, Charlson comorbidity index and were independently associated with 18-month mortality. The model to predict 18-month mortality showed excellent discrimination (optimism corrected c-statistic = 0.822) and calibration (corrected slope = 0.893). GRACE and TARRACO scores had moderate discrimination [c-statistic = 0.748 (95% CI 0.652–0.843) and 0.741, 95% CI 0.669–0.805), respectively] and inferior compared with model (p = 0.043 and 0.037, respectively). Conclusions: The risk of mortality among T2MI patients could be accurately predicted by using common clinical characteristics and laboratory tests. Further studies are required with external validation of nomogram prior to clinical implementation. © 2021 Elsevier Inc

Concordance and Prognostic Relevance of Angiographic and Clinical Definitions of Myocardial Infarction Type

Background: Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis. Methods: Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed. Results: Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had “true” T1MI (atherothrombosis+ / triggers−); 174 (24.4%) were diagnosed with “true” T2MI (atherothrombosis− / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), P = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, P < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, P = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), P = 0.013 Conclusion: Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients. © The Author(s) 2021

Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is diagnosed in the absence of anatomically significant stenoses (<50% of lumen diameter) on coronary angiography and characterized by heterogeneity of etiologic factors. Recently, the mechanisms of MINOCA as well as the performance of diagnostic algorithms and therapeutic strategies have been extensively studied. The purpose of this review is to reflect the current concepts regarding the etiology and pathogenesis of MINOCA, diagnostic work-up methods and individualized treatment approaches. The article covers contemporary epidemiologic data, demographic and clinical patients' characteristics and principal causes of MINOCA. We discuss aspects of disease definition and classification of related conditions involving troponin increase in the presence of normal coronary arteries. The importance of management strategy personalization for individual patients is stressed alongside stratification of risks of recurrent cardiovascular events. This review reflects key points from international consensus statements published by leading experts and suggests promising directions for future research

Discordance between the clinical presentation and morphology of myocardial infarction in a patient with acute post-hemorrhagic anemia

While atherosclerotic plaque disruption remains the hallmark of type 1 myocardial infarction (T1MI), multiple other mechanisms provoking myocardial supply/demand mismatch (eg, anemia and tachyarrhythmias) are recognized as the potential causes of type 2 myocardial infarction (T2MI). In clinical practice, angiography is underutilized in patients with MI that have typical T2MI triggers, although the presence of these triggers and various forms of atherosclerotic coronary artery disease is not mutually exclusive. We describe a 70-year-old man that developed MI during hospitalization for gastrointestinal bleeding. He was treated conservatively without angiography due to posthemorrhagic anemia, which is a recognized T2MI trigger, and subsequently developed refractory cardiogenic shock. Autopsy revealed atherothrombosis, which is characteristic of T1MI. © 2020, Tehran Heart Center. All rights reserved

КЛИНИКО-ДЕМОГРАФИЧЕСКИЕ ХАРАКТЕРИСТИКИ, РАСПРОСТРАНЕННОСТЬ ФАКТОРОВ РИСКА И СОПУТСТВУЮЩИХ ЗАБОЛЕВАНИЙ У ПАЦИЕНТОВ С ИНФАРКТОМ МИОКАРДА 2-ГО ТИПА

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 2) и t-критерий Стьюдента. Для выявления взаимосвязи отдельных параметров с типом ИМ использовались процедуры однофакторного и многофакторного логистического регрессионного анализа. Результаты: ИМ2Т был диагностирован у 175 (38,9%) пациентов с преобладанием среди них лиц старшего возраста (р = 0,007) и женского пола (р = 0,01). При ИМ2Т реже регистрировался подъем сегмента ST (р = 0,001) и отмечались более низкие значения тропонина (р = 0,001). Пациенты с ИМ2Т чаще имели анамнез ранее перенесенного ИМ (р 0,05). Независимыми предикторами ИМ2Т были наличие анемии (р < 0,001), блокада левой ножки пучка Гиса (р = 0,019), отсутствие подъема сегмента ST на ЭКГ (р = 0,001), возраст ≥ 70 лет (р = 0,014) и нарушений локального сократимости при эхокардиографии (р = 0,002). Заключение: Инфаркт миокарда 2-го типа выявляется у значительной части пациентов с ИМ и независимо ассоциирован с пожилым возрастом, сопутствующей анемией, блокадой левой ножки пучка Гиса, отсутствием подъема ST на ЭКГ, нормальной сократимостью левого желудочка по данным эхокардиографии