Singh Avinainder, Gupta Ankur, DeFilippis Ersilia M, Qamar Arman, Biery David W, Almarzooq Zaid, Collins Bradley, Fatima Amber, Jackson Candace, Galazka Patrycja, Ramsis Mattheus, Pipilas Daniel C, Divakaran Sanjay, Cawley Mary, Hainer Jon, Klein Josh, Jarolim Petr, Nasir Khurram, Januzzi James L, Di Carli Marcelo F, Bhatt Deepak L, Blankstein Ron
Department of Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: https://twitter.com/AvinainderSingh.
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.
J Am Coll Cardiol. 2020 Mar 10;75(9):1003-1013. doi: 10.1016/j.jacc.2019.12.052.
Type 2 myocardial infarction (MI) and myocardial injury are associated with increased short-term mortality. However, data regarding long-term mortality are lacking.
This study compared long-term mortality among young adults with type 1 MI, type 2 MI, or myocardial injury.
Adults age 50 years or younger who presented with troponin >99th percentile or the International Classification of Diseases code for MI over a 17-year period were identified. All cases were adjudicated as type 1 MI, type 2 MI, or myocardial injury based on the Fourth Universal Definition of MI. Cox proportional hazards models were constructed for survival free from all-cause and cardiovascular death.
The cohort consisted of 3,829 patients (median age 44 years; 30% women); 55% had type 1 MI, 32% had type 2 MI, and 13% had myocardial injury. Over a median follow-up of 10.2 years, mortality was highest for myocardial injury (45.6%), followed by type 2 MI (34.2%) and type 1 MI (12%) (p < 0.001). In an adjusted model, type 2 MI was associated with higher all-cause (hazard ratio: 1.8; 95% confidence interval: 1.2 to 2.7; p = 0.004) and cardiovascular mortality (hazard ratio: 2.7; 95% confidence interval: 1.4 to 5.1; p = 0.003) compared with type 1 MI. Those with type 2 MI or myocardial injury were younger and had fewer cardiovascular risk factors but had more noncardiovascular comorbidities. They were significantly less likely to be prescribed cardiovascular medications at discharge.
Young patients who experience a type 2 MI have higher long-term all-cause and cardiovascular mortality than those who experience type 1 MI, with nearly one-half of patients with myocardial injury and more than one-third of patients with type 2 MI dying within 10 years. These findings emphasize the need to provide more aggressive secondary prevention for patients who experience type 2 MI and myocardial injury.
2型心肌梗死（MI）和心肌损伤与短期死亡率增加相关。然而，关于长期死亡率的数据尚缺。
本研究比较了1型MI、2型MI或心肌损伤的年轻成年人的长期死亡率。
确定在17年期间肌钙蛋白>第99百分位数或出现MI的国际疾病分类代码的50岁及以下成年人。根据MI的第四版通用定义，所有病例均判定为1型MI、2型MI或心肌损伤。构建Cox比例风险模型以评估全因死亡和心血管死亡的无事件生存率。
该队列由3829名患者组成（中位年龄44岁；30%为女性）；55%为1型MI，32%为2型MI，13%为心肌损伤。在中位随访10.2年期间，心肌损伤患者的死亡率最高（45.6%），其次是2型MI患者（34.2%）和1型MI患者（12%）（p<0.001）。在调整模型中，与1型MI相比，2型MI与更高的全因死亡率（风险比：1.8；95%置信区间：1.2至2.7；p=0.004）和心血管死亡率（风险比：2.7；95%置信区间：1.4至5.1；p=0.003）相关。2型MI或心肌损伤患者更年轻，心血管危险因素更少，但非心血管合并症更多。他们出院时接受心血管药物治疗的可能性显著更低。
发生2型MI的年轻患者的长期全因死亡率和心血管死亡率高于发生1型MI的患者，近一半的心肌损伤患者和超过三分之一的2型MI患者在10年内死亡。这些发现强调了对发生2型MI和心肌损伤的患者提供更积极二级预防的必要性。
