Type-II Myocardial Infarction – Patient Characteristics, Management and Outcomes

<div><p>Background</p><p>Type-II MI is defined as myocardial infarction (MI) secondary to ischemia due to either increased oxygen demand or decreased supply. This categorization has been used for the last five years, yet, little is known about patient characteristics and clinical outcomes. In the current work we assessed the epidemiology, causes, management and outcomes of type II MI patients.</p><p>Methods</p><p>A comparative analysis was performed between patients with type-I and type-II MI who participated in two prospective national Acute Coronary Syndrome Israeli Surveys (ACSIS) performed in 2008 and 2010.</p><p>Results</p><p>The surveys included 2818 patients with acute MI of whom 127 (4.5%) had type-II MI. The main causes of type-II MI were anemia (31%), sepsis (24%), and arrhythmia (17%). Patients with type-II MI tended to be older (75.6±12 vs. 63.8±13, p<0.0001), female majority (43.3% vs. 22.3%, p<0.0001), had more frequently impaired functional level (45.7% vs. 17%, p<0.0001) and a higher GRACE risk score (150±32 vs. 110±35, p<0.0001). Patients with type-II MI were significantly less often referred for coronary interventions (36% vs. 89%, p<0.0001) and less frequently prescribed guideline-directed medical therapy. Mortality rates were substantially higher among patients with type-II MI both at thirty-day (13.6% vs. 4.9%, p<0.0001) and at one-year (23.9% vs. 8.6%, p<0.0001) follow-ups.</p><p>Conclusions</p><p>Patients with type-II compared to type-I MI have distinct demographics, increased prevalence of multiple comorbidities, a high-risk cardiovascular profile and an overall worse outcome. The complex medical condition of this cohort imposes a great therapeutic challenge and specific guidelines with recommended medical treatment and invasive strategies are warranted.</p></div

Presentation of myocardial infarction.

<p>Intensive or intermediate cardiac care units.</p

Patient characteristics.

<p>BMI – body mass index.</p><p>PCI – per-cutaneous intervension.</p><p>CABG – coronary artery bypass grafting.</p><p>CVA – cerebrovascular event.</p><p>TIA – transient ischemic attack.</p><p>COPD - chronic obstructive pulmonary disease.</p

Guideline-directed medications at discharge.

<p>ACE-I - angiotensin converting enzyme inhibitors.</p><p>ARB - angiotensin receptor blocker.</p

Kaplan-Meier Survival Analysis, Type-I vs. Type-II Myocardial Infarction.

<p>Kaplan-Meier survival analysis shows significant differences between groups with overall reduced one-year survival rates among patients with type-II MI (76.1% vs. 91.4%, p<0.0001).</p

Reperfusion therapy.

<p>PCI - per cutaneous intervention.</p><p>LMCA - left main coronary artery.</p><p>LAD - left anterior descending coronary artery.</p><p>LCX - left circumflex coronary artery.</p><p>RCA - right coronary artery.</p><p>CABG - coronary artery bypass graft.</p><p>Percentage of all patients who had undergone angiography.</p