College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia.
Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia.
PLoS One. 2021 Mar 12;16(3):e0248289. doi: 10.1371/journal.pone.0248289. eCollection 2021.
The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury.
We included all patients presenting to public emergency departments in South Australia between June 2011-Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia.
372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia.
Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.
心肌梗死（MI）的第四通用定义将 MI 与心肌损伤区分开来。我们描述了与 MI、急性和慢性心肌损伤相关的心脏和非心脏结局的时间进程。
我们纳入了 2011 年 6 月至 2019 年 9 月期间在南澳大利亚州公共急诊部门就诊的所有患者。根据高敏肌钙蛋白 T（hs-cTnT）和诊断代码，将每个医疗事件（EOC）分为 5 组：1）急性 MI [hs-cTnT 升高/降低和急性冠状动脉综合征的主要诊断]，2）有冠心病（CAD）的急性心肌损伤 [hs-cTnT 升高/降低和 CAD 的诊断]，3）无 CAD 的急性心肌损伤 [hs-cTnT 升高/降低且无 CAD 的诊断]，4）慢性心肌损伤 [hs-cTnT 升高但无升高/降低]，和 5）无心肌损伤。采用多变量灵活参数模型描述死亡、MI、心力衰竭（HF）和室性心律失常的时间风险。
共纳入 372310 个 EOC（218878 人）：急性 MI（19052 [5.12%]），有 CAD 的急性心肌损伤（6928 [1.86%]），无 CAD 的急性心肌损伤（32231 [8.66%]），慢性心肌损伤（55056 [14.79%]），无心肌损伤（259043 [69.58%]）。我们观察到急性 MI 和有 CAD 的急性心肌损伤后早期存在 MI 和 HF 风险。相比之下，在无 CAD 或慢性损伤的急性损伤患者中，随后的 MI 风险较低且更稳定。所有类型的心肌损伤都与全因死亡率和室性心律失常的风险显著增加相关。
不同类型的心肌损伤与后续心脏和非心脏风险的不同模式相关。需要进一步研究此类额外风险的治疗方法和可改变性。
