Department of Medicine, University of Washington, Seattle.
Department of Medicine, University of Washington, Seattle2Department of Epidemiology, University of Washington, Seattle.
JAMA Cardiol. 2017 Mar 1;2(3):260-267. doi: 10.1001/jamacardio.2016.5139.
The Second Universal Definition of Myocardial Infarction (MI) divides MIs into different types. Type 1 MIs result spontaneously from instability of atherosclerotic plaque, whereas type 2 MIs occur in the setting of a mismatch between oxygen demand and supply, as with severe hypotension. Type 2 MIs are uncommon in the general population, but their frequency in human immunodeficiency virus (HIV)-infected individuals is unknown.
To characterize MIs, including type; identify causes of type 2 MIs; and compare demographic and clinical characteristics among HIV-infected individuals with type 1 vs type 2 MIs.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal study identified potential MIs among patients with HIV receiving clinical care at 6 US sites from January 1, 1996, to March 1, 2014, using diagnoses and cardiac biomarkers recorded in the centralized data repository. Sites assembled deidentified packets, including physician notes and electrocardiograms, procedures, and clinical laboratory tests. Two physician experts adjudicated each event, categorizing each definite or probable MI as type 1 or type 2 and identifying the causes of type 2 MI.
The number and proportion of type 1 vs type 2 MIs, demographic and clinical characteristics among those with type 1 vs type 2 MIs, and the causes of type 2 MIs.
Among 571 patients (median age, 49 years [interquartile range, 43-55 years]; 430 men and 141 women) with definite or probable MIs, 288 MIs (50.4%) were type 2 and 283 (49.6%) were type 1. In analyses of type 1 MIs, 79 patients who underwent cardiac interventions, such as coronary artery bypass graft surgery, were also included, totaling 362 patients. Sepsis or bacteremia (100 [34.7%]) and recent use of cocaine or other illicit drugs (39 [13.5%]) were the most common causes of type 2 MIs. A higher proportion of patients with type 2 MIs were younger than 40 years (47 of 288 [16.3%] vs 32 of 362 [8.8%]) and had lower current CD4 cell counts (median, 230 vs 383 cells/µL), lipid levels (mean [SD] total cholesterol level, 167 [63] vs 190 [54] mg/dL, and mean (SD) Framingham risk scores (8% [7%] vs 10% [8%]) than those with type 1 MIs or who underwent cardiac interventions.
Approximately half of all MIs among HIV-infected individuals were type 2 MIs caused by heterogeneous clinical conditions, including sepsis or bacteremia and recent use of cocaine or other illicit drugs. Demographic characteristics and cardiovascular risk factors among those with type 1 and type 2 MIs differed, suggesting the need to specifically consider type among HIV-infected individuals to further understand MI outcomes and to guide prevention and treatment.
心肌梗死（MI）的第二代通用定义将 MI 分为不同类型。1 型 MI 是由动脉粥样硬化斑块不稳定自发引起的，而 2 型 MI 则发生在严重低血压等情况下的氧供需不匹配。2 型 MI 在普通人群中并不常见，但在人类免疫缺陷病毒（HIV）感染者中的发生率尚不清楚。
描述 MI，包括类型；确定 2 型 MI 的原因；并比较 HIV 感染者中 1 型和 2 型 MI 的人口统计学和临床特征。
设计、地点和参与者：这项纵向研究使用集中数据存储库中记录的诊断和心脏生物标志物，在 6 个美国地点从 1996 年 1 月 1 日至 2014 年 3 月 1 日，对接受临床护理的 HIV 患者中潜在的 MI 进行了鉴定。各地点收集了匿名数据包，包括医生的笔记和心电图、程序和临床实验室测试。两名医生专家对每个事件进行裁决，将每个确定或可能的 MI 分类为 1 型或 2 型，并确定 2 型 MI 的原因。
1 型和 2 型 MI 的数量和比例，1 型和 2 型 MI 患者的人口统计学和临床特征，以及 2 型 MI 的原因。
在 571 名（中位数年龄，49 岁[四分位距，43-55 岁]；430 名男性和 141 名女性）确定或可能的 MI 患者中，288 例（50.4%）为 2 型 MI，283 例（49.6%）为 1 型 MI。在 1 型 MI 的分析中，还包括了 79 例接受了冠状动脉旁路移植术等心脏介入治疗的患者，共计 362 例。败血症或菌血症（100 例[34.7%]）和近期使用可卡因或其他非法药物（39 例[13.5%]）是 2 型 MI 最常见的原因。更多的 2 型 MI 患者年龄小于 40 岁（47/288[16.3%]比 32/362[8.8%]），当前 CD4 细胞计数较低（中位数，230 比 383 细胞/µL），血脂水平（总胆固醇水平的均值[标准差]，167[63]比 190[54]mg/dL，均值[标准差]Framingham 风险评分（8%[7%]比 10%[8%]）低于 1 型 MI 或接受心脏介入治疗的患者。
在 HIV 感染者中，大约一半的 MI 为 2 型 MI，由不同的临床情况引起，包括败血症或菌血症以及近期使用可卡因或其他非法药物。1 型和 2 型 MI 患者的人口统计学特征和心血管危险因素不同，这表明需要根据具体情况考虑 MI 类型，以进一步了解 MI 结局，并指导预防和治疗。
