Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
School of Medicine, The University of Queensland, Herston, Queensland, Australia.
Emerg Med J. 2018 Mar;35(3):169-175. doi: 10.1136/emermed-2017-206869. Epub 2017 Aug 7.
To identify differences in prevalence, demographics, clinical features and outcomes for type 1 myocardial infarction (T1MI) and type 2 myocardial infarction (T2MI) in a cohort of patients presenting to the Emergency Department (ED) with chest pain.
This was a post hoc analysis of data collected from two prospective studies. Data were collected between November 2008 and February 2011 for the first study, and between February 2011 and March 2014 for the second. Participants were patients presenting to the ED with symptoms suggestive of acute coronary syndrome (ACS). The outcome was 30-day diagnosis; classified into T1MI, T2MI or non-MI. Descriptive statistics were used to compare the demographics, clinical history and presenting symptoms across diagnoses (T1MI, T2MI and non-MI). Cumulative mortality over 1 year was compared for T1MI and T2MI.
147 patients (6.3%; 95% CI 5.3% to 7.3%) were classified as T1MI and 52 (2.2%; 95% CI 1.7% to 2.9%) were classified as T2MI. T2MIs were more likely to be female (OR 4.71, 95% CI 2.28 to 9.76), have an abnormal but non-ischaemic ECG (OR 2.95, 95% CI 1.45 to 6.00), report prior hypertension (OR 2.83, 95% CI 1.35 to 6.12), have tachycardia (OR 9.26, 95% CI 3.08 to 30.77) and pain at rest (OR 3.04, 95% CI 1.28 to 8.02) compared with T1MI. One-year mortality was similar between T1MI and T2MI (9% and 14.6%, respectively, p=0.37).
T2MIs comprised one quarter of all MIs diagnosed in the ED. Among patients presenting to the ED with symptoms of ACS, symptoms do not allow clinicians to reliably differentiate patients with T1MI and T2MI. Prior hypertension, tachycardia and abnormal non-ischaemic ECGs are seen more often in T2MI compared with T1MI. One-year mortality was substantial in patients with T1MI and T2MI, but low power precludes conclusions about mortality differences between groups.
在因胸痛而到急诊科就诊的患者中，确定 1 型心肌梗死（T1MI）和 2 型心肌梗死（T2MI）的患病率、人口统计学特征、临床特征和结局的差异。
这是对两项前瞻性研究数据进行的事后分析。第一项研究的数据收集时间为 2008 年 11 月至 2011 年 2 月，第二项研究的数据收集时间为 2011 年 2 月至 2014 年 3 月。研究对象为因疑似急性冠脉综合征（ACS）而到急诊科就诊的患者。结局为 30 天诊断；分为 T1MI、T2MI 或非 MI。使用描述性统计数据比较不同诊断（T1MI、T2MI 和非 MI）的人口统计学、临床病史和表现症状。比较 T1MI 和 T2MI 患者在 1 年内的累积死亡率。
147 例患者（6.3%；95%置信区间 5.3%至 7.3%）被归类为 T1MI，52 例患者（2.2%；95%置信区间 1.7%至 2.9%）被归类为 T2MI。T2MI 更可能为女性（比值比 4.71，95%置信区间 2.28 至 9.76），心电图异常但非缺血性（比值比 2.95，95%置信区间 1.45 至 6.00），报告有既往高血压（比值比 2.83，95%置信区间 1.35 至 6.12），心动过速（比值比 9.26，95%置信区间 3.08 至 30.77）和静息时疼痛（比值比 3.04，95%置信区间 1.28 至 8.02），与 T1MI 相比。T1MI 和 T2MI 的 1 年死亡率相似（分别为 9%和 14.6%，p=0.37）。
T2MI 占急诊科诊断的所有 MI 的四分之一。在因 ACS 症状而到急诊科就诊的患者中，症状不能让临床医生可靠地区分 T1MI 和 T2MI 患者。与 T1MI 相比，T2MI 中更常见既往高血压、心动过速和异常非缺血性心电图。T1MI 和 T2MI 患者的 1 年死亡率较高，但由于效能低，无法得出两组之间死亡率差异的结论。
