Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Eur Heart J. 2017 Dec 14;38(47):3514-3520. doi: 10.1093/eurheartj/ehx457.
The differentiation of type 1 and type 2 myocardial infarction (T1MI, T2MI) is important, but challenging in the emergency department. We aimed to investigate the clinical characteristics and cardiovascular outcome of T2MI patients and to develop a clinical decision tool to differentiate T1MI and T2MI patients.
We prospectively enrolled 1548 patients with suspected MI. All patients were followed for up to 2 years to assess mortality. We used logistic regression with backward step-down selection to determine the most important predictors of T2MI. Based on these regression coefficients, we developed a diagnostic prediction model (score) to diagnose T2MI. T2MI was the final diagnosis of 99 patients. Patients with T2MI showed a high 1-year mortality rate (13.8%), which equals that of T1MI patients (9.4%). Female sex (Beta 1.27 [95% confidence interval; CI 0.67-1.90]), not having radiating chest pain (Beta 1.62 [CI 0.96-2.34]) and a baseline high-sensitivity troponin I concentration ≤ 40.8 ng/L (Beta 1.30 [CI 0.74-1.89]) were the strongest predictors for T2MI. Their combination resulted in an area under the curve of 0.71 to discriminate T1MI and T2MI. The binary score based on this model assigns one point to each of the predictors. Patients with the highest score value of 3 had a 72% probability of T2MI.
T2MI patients are a heterogeneous population with high-cardiovascular risk. A score based on laboratory and clinical parameters might help to differentiate T1MI and T2MI patients. The additional use of this score in clinical routine needs to be investigated prospectively.
www.clinicaltrials.gov (NCT02355457).
1 型和 2 型心肌梗死（T1MI、T2MI）的鉴别很重要，但在急诊科具有挑战性。我们旨在研究 T2MI 患者的临床特征和心血管结局，并开发一种临床决策工具来区分 T1MI 和 T2MI 患者。
我们前瞻性纳入了 1548 名疑似 MI 的患者。所有患者均随访至 2 年，以评估死亡率。我们使用向后逐步选择的逻辑回归来确定 T2MI 的最重要预测因素。基于这些回归系数，我们开发了一种诊断预测模型（评分）来诊断 T2MI。最终诊断为 99 例 T2MI。T2MI 患者的 1 年死亡率较高（13.8%），与 T1MI 患者（9.4%）相当。女性（Beta 1.27[95%置信区间；CI 0.67-1.90]）、无放射状胸痛（Beta 1.62[CI 0.96-2.34]）和基线高敏肌钙蛋白 I 浓度≤40.8ng/L（Beta 1.30[CI 0.74-1.89]）是 T2MI 的最强预测因素。将这些因素结合起来，区分 T1MI 和 T2MI 的曲线下面积为 0.71。基于该模型的二项评分，每个预测因素记 1 分。得分最高的 3 分患者有 72%的可能性患有 T2MI。
T2MI 患者是一个具有高心血管风险的异质人群。基于实验室和临床参数的评分可能有助于区分 T1MI 和 T2MI 患者。需要前瞻性地研究该评分在临床常规中的额外应用。
