Baron Tomasz, Hambraeus Kristina, Sundström Johan, Erlinge David, Jernberg Tomas, Lindahl Bertil
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Sweden.
Department of Cardiology, Falun Hospital, Falun, Sweden.
Am J Med. 2016 Apr;129(4):398-406. doi: 10.1016/j.amjmed.2015.11.035. Epub 2016 Jan 4.
In contrast to the associated-with-thromboembolic-event type 1 myocardial infarction, type 2 myocardial infarction is caused by acute imbalance between oxygen supply and demand of myocardium. Type 2 myocardial infarction may be present in patients with or without obstructive coronary artery disease, but knowledge about patient characteristics, treatments, and outcome in relation to coronary artery status is lacking. We aimed to compare background characteristics, triggering mechanisms, treatment, and long-term prognosis in a large real-life cohort of patients with type 1 and type 2 myocardial infarction with and without obstructive coronary artery disease.
All 41,817 consecutive patients with type 1 and type 2 myocardial infarction registered in the Swedish myocardial infarction registry (SWEDEHEART) who underwent coronary angiography between January 1, 2011 and December 31, 2013, with the last follow-up on December 31, 2014, were studied.
In 92.8% of 40,501 patients classified as type 1 and in 52.5% of patients classified as type 2 myocardial infarction, presence of an obstructive coronary artery disease could be shown. Within the patients with obstructive coronary artery disease, those with type 2 myocardial infarction were older, and had more comorbidities and smaller necrosis as compared with type 1 myocardial infarction. In contrast, there was almost no difference in risk profile and extent of myocardial infarction between type 1 and type 2 myocardial infarction patients with nonobstructive coronary artery stenosis. The crude long-term mortality was higher in type 2 as compared with type 1 myocardial infarction with obstructive coronary artery disease (hazard ratio [HR] 1.72; 95% confidence interval [CI], 1.45-2.03), but was lower after adjustment (HR 0.76; 95% CI, 0.61-0.94). In myocardial infarction patients with nonobstructive coronary artery stenosis, the mortality risk was similar regardless of the clinical myocardial infarction type (crude HR 1.14; 95% CI, 0.84-1.55; adjusted HR 0.82; 95% CI, 0.52-1.29).
The substantial differences in risk factors, treatment, and outcome in patients with type 1 and type 2 myocardial infarction with obstructive coronary artery disease supports the relevance of the division between type 1 and type 2 in this population. On the contrary, in patients with nonobstructive coronary artery stenosis, irrespective of the clinical type, a similar risk profile, extent of necrosis, and long-term prognosis were observed, indicating that distinction between type 1 and type 2 myocardial infarction in these patients seems to be inappropriate.
与伴有血栓栓塞事件的1型心肌梗死不同，2型心肌梗死是由心肌氧供需急性失衡所致。2型心肌梗死可出现在有或无阻塞性冠状动脉疾病的患者中，但缺乏关于患者特征、治疗以及与冠状动脉状态相关的结局的知识。我们旨在比较一大组现实生活中伴有或不伴有阻塞性冠状动脉疾病的1型和2型心肌梗死患者的背景特征、触发机制、治疗及长期预后。
对2011年1月1日至2013年12月31日期间在瑞典心肌梗死登记处（SWEDEHEART）登记的、接受冠状动脉造影且在2014年12月31日进行最后一次随访的所有41817例连续性1型和2型心肌梗死患者进行研究。
在分类为1型的40501例患者中，92.8%以及在分类为2型心肌梗死的患者中，52.5%可显示存在阻塞性冠状动脉疾病。在阻塞性冠状动脉疾病患者中，2型心肌梗死患者比1型心肌梗死患者年龄更大，合并症更多，坏死面积更小。相反，在无阻塞性冠状动脉狭窄的1型和2型心肌梗死患者之间，风险特征和心肌梗死范围几乎没有差异。在伴有阻塞性冠状动脉疾病的情况下，2型心肌梗死的粗长期死亡率高于1型心肌梗死（风险比[HR]1.72；95%置信区间[CI]，1.45 - 2.03），但调整后较低（HR 0.76；95% CI，0.61 - 0.94）。在无阻塞性冠状动脉狭窄的心肌梗死患者中，无论临床心肌梗死类型如何，死亡风险相似（粗HR 1.14；95% CI，0.84 - 1.55；调整后HR 0.82；95% CI，0.52 - 1.29）。
伴有阻塞性冠状动脉疾病的1型和2型心肌梗死患者在危险因素、治疗和结局方面的显著差异支持了在该人群中区分1型和2型的相关性。相反，在无阻塞性冠状动脉狭窄的患者中，无论临床类型如何，观察到相似的风险特征、坏死范围和长期预后，这表明在这些患者中区分1型和2型心肌梗死似乎并不合适。
