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- Title
Major adverse cardiovascular events after diagnosis of myocardial injury and types 1 and 2 myocardial infarction.
- Authors
Knott, Jonathan D; Ola, Olatunde; Michieli, Laura De; Akula, Ashok; Mehta, Ramila A; Dworak, Marshall; Crockford, Erika; Lobo, Ronstan; Rastas, Nicholas; Karturi, Swetha; Wohlrab, Scott; Hodge, David O; Grube, Eric; Tak, Tahir; Cagin, Charles; Gulati, Rajiv; Jaffe, Allan S; Sandoval, Yader
- Abstract
Aims Limited US outcome data exist among patients with myocardial injury and types 1 and 2 myocardial infarction (MI) evaluated with high-sensitivity cardiac troponin (hs-cTn). Methods and results This is an observational US cohort study of emergency department (ED) patients undergoing hs-cTnT measurement. Cases with ≥1 hs-cTnT increase >99th percentile were adjudicated following the Fourth Universal Definition of MI. Post-discharge major adverse cardiovascular events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischaemic attack, and new-onset atrial fibrillation or flutter during 2 years follow-up. Among 2002 patients, 857 (43%) had ≥1 hs-cTnT >99th percentile. Among these, 702 (81.9%) had myocardial injury, 64 (7.5%) had type 1 MI, and 91 (10.6%) had type 2 MI. Compared with patients without myocardial injury, type 2 MI [8.4 vs. 50%; adjusted hazard ratio (HR) 2.31, 95% confidence interval (CI) 1.49–3.58] and myocardial injury (8.4 vs. 47%; adjusted HR 3.13, 95% CI 2.39–4.09) had a higher risk of MACE, in large part because of death and HF hospitalizations. Compared with patients with type 1 MI, type 2 MI (23 vs. 50%; adjusted HR 2.24; 95% CI 1.23–4.10) and myocardial injury (23 vs. 47%; adjusted HR 2.02; 95% CI 1.20–3.40) also have a higher risk of MACE. Conclusion Among unselected US ED patients undergoing hs-cTnT measurement, most increases are due to myocardial injury, and type 2 MI is more frequent than type 1 MI. Patients with myocardial injury and type 2 MI have morbid outcomes, in large part due to death and HF.
- Publication
European Heart Journal: Acute Cardiovascular Care, 2022, Vol 11, Issue 7, p546
- ISSN
2048-8726
- Publication type
Article
- DOI
10.1093/ehjacc/zuac075