定义对 2 型心肌梗死发病率和预后的影响。
Effect of Definition on Incidence and Prognosis of Type 2 Myocardial Infarction.
机构信息
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University Basel, Basel, Switzerland; GREAT Network, Rome, Italy.
Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland; GREAT Network, Rome, Italy.
出版信息
J Am Coll Cardiol. 2017 Sep 26;70(13):1558-1568. doi: 10.1016/j.jacc.2017.07.774.
BACKGROUND
Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice.
OBJECTIVES
This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need.
METHODS
The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI).
RESULTS
Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI definition was 2.8% (n = 112). The application of the more liberal T2MI definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI). Among T2MI, 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI, which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI vs. T2MI and T1MI: p = 0.03 and 0.01, respectively).
CONCLUSIONS
T2MI has a substantially lower event-related mortality rate compared with T2MI and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).
背景
由于供需不匹配导致 2 型心肌梗死（T2MI）的定义和治疗存在不确定性，这导致其在临床实践中的应用不一致。
目的
本研究旨在更好地了解 T2MI 定义对其发病率、治疗和与事件相关死亡率的影响，从而满足一个重要的未满足的临床需求。
方法
通过 2 种方法，由 2 位独立的心脏病专家对出现疑似心肌梗死症状的患者进行最终诊断：1 种方法需要存在冠状动脉疾病，这是 2007 年通用定义（T2MI）的常见解释；1 种方法不需要冠状动脉疾病，这是 2012 年通用定义（T2MI）。
结果
共有 4015 例连续患者进行了裁决。根据 T2MI 定义，T2MI 的发生率为 2.8%（n=112）。应用更宽松的 T2MI 定义会使 T2MI 的发生率增加 6%（n=240），相对增加 114%（128 例重新分类的患者被定义为 T2MI）。在 T2MI 中，有 6.3%的患者接受了冠状动脉血运重建，22%接受了双联抗血小板治疗，71%接受了大剂量他汀类药物治疗，而 T2MI 患者分别为 0.8%、1.6%和 31%（均 p<0.01）。90 天的心血管死亡率在 T2MI 中为 0%，与因非心脏原因引起胸痛的患者相似（0.2%），低于 T2MI（3.6%）和 1 型心肌梗死（T1MI）（4.8%）（T2MI 与 T2MI 和 T1MI 相比：p=0.03 和 0.01）。
结论
与 T2MI 和 T1MI 相比，T2MI 的相关死亡率显著降低。（急性冠状动脉综合征评估的优势预测因子研究；NCT00470587）。
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