3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
Clin Res Cardiol. 2019 Jul;108(7):749-762. doi: 10.1007/s00392-018-1403-3. Epub 2018 Dec 7.
Classifying myocardial infarction into type 1 (T1MI) or type 2 (T2MI) remains a challenge in clinical practice. We aimed to identify factors contributing to variation in the classifications of MI into type 1 or type 2. In addition, pooled analyses of long-term mortality and reinfarction outcomes were performed.
We searched Medline, Embase and Web of Science through January 2018 for observational studies or clinical trials classifying patients as either T1MI or T2MI. Studies with baseline characteristics allowing a comparison between both groups were included. Inverse variance random-effects models were used to pool risk ratios (RR).
Overall, 93,194 patients from 20 included observational studies were classified as T1MI and 9291 as T2MI; corresponding to 87.9% and 8.8% of all patients diagnosed with MI. Inclusion of ST-elevation MI patients was inconsistent among studies. Coronary angiography was performed in 77.7% and 31.5% of all patients with T1MI and T2MI, respectively. From a subgroup of 11 studies, percutaneous coronary intervention was performed in 79.2% of all patients classified as T1MI (range 44.2-93.0%) and 40.2% of all T2MI patients (range 0-87.5%). A meta-analysis of 6 studies (44,366 in total) on 2-year mortality showed worse outcome among T2MI patients (RR: 1.52, CI 1.07-2.17, P = 0.02; I = 92%). Risk of reinfarction at 1.6 years was higher among T2MI patients (RR: 1.68, CI 1.22-2.31, P = 0.001; I = 9%).
Classification of T1MI and T2MI varies widely among studies. A standardized approach with clear definitions is needed to avoid misclassification and ensure appropriate patient management.
将心肌梗死分为 1 型（T1MI）或 2 型（T2MI）在临床实践中仍然具有挑战性。我们旨在确定导致 MI 分类为 1 型或 2 型的变化因素。此外，还对长期死亡率和再梗死结局进行了汇总分析。
我们通过 2018 年 1 月在 Medline、Embase 和 Web of Science 上搜索了将患者分类为 T1MI 或 T2MI 的观察性研究或临床试验。纳入了允许对两组进行比较的基线特征研究。采用逆方差随机效应模型对风险比（RR）进行汇总。
共有 20 项观察性研究中的 93194 名患者被归类为 T1MI，9291 名患者被归类为 T2MI；分别占所有诊断为 MI 患者的 87.9%和 8.8%。纳入的 ST 段抬高型心肌梗死患者在各研究中不一致。冠状动脉造影分别在 T1MI 和 T2MI 患者中的比例为 77.7%和 31.5%。从 11 项研究的亚组中，所有归类为 T1MI 的患者中有 79.2%（范围为 44.2-93.0%）和所有 T2MI 患者中有 40.2%（范围为 0-87.5%）接受了经皮冠状动脉介入治疗。6 项研究（共 44366 例患者）对 2 年死亡率进行的荟萃分析显示，T2MI 患者的结局更差（RR：1.52，95%CI：1.07-2.17，P=0.02；I²=92%）。T2MI 患者在 1.6 年时再梗死的风险更高（RR：1.68，95%CI：1.22-2.31，P=0.001；I²=9%）。
T1MI 和 T2MI 的分类在研究中差异很大。需要采用明确定义的标准化方法，以避免分类错误并确保适当的患者管理。
