Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics, Institute of Medicine, 64948RUDN University, Moscow, Russia.
Vinogradov Moscow City Clinical Hospital, Moscow, Russia.
J Cardiovasc Pharmacol Ther. 2021 Sep;26(5):463-472. doi: 10.1177/10742484211005929. Epub 2021 Apr 9.
Atherothrombosis is the principal mechanism of type 1 (T1) myocardial infarction (MI), while type 2 (T2) MI is typically diagnosed in the presence of triggers (anemia, arrhythmia, etc.). We aimed to evaluate the proportions of T1 vs. T2 MI based on angiographic and clinical definitions, their concordance and prognosis.
Consecutive MI patients [n = 712, 61% male; age 64.6 ± 12.3 years] undergoing coronary angiography were classified according to the presence of atherothrombosis and identifiable triggers. Association of angiographic and clinical MI type criteria with adverse outcomes (Time follow-up was 1.5 years) was evaluated. Predictive ability of GRACE risk score for all-cause mortality was then assessed.
Atherothrombosis and clinical triggers were identified in 397 (55.6%) and 324 (45.5%) subjects, respectively. Only 247 (34.7%) patients had "true" T1MI (atherothrombosis+ / triggers-); 174 (24.4%) were diagnosed with "true" T2MI (atherothrombosis- / triggers+), while 291 (40.9%) had discordant clinical and angiographic characteristics. All-cause mortality in T2MI (20.1%) patients was higher than in T1MI (9.3%), = 0.002. Presence of triggers [odds ratio (OR) 2.4, 95% CI 1.5-3.6, < 0.0001] but not atherothrombosis [OR 0.8, 95% confidence interval (CI) 0.5-1.3, = 0.26] was associated with worse prognosis. GRACE score is a better predictor of death in T1MI vs. T2MI: area under curve 0.893 (95% CI 0.830-0.956) vs 0.748 (95% CI 0.652-0.843), = 0.013.
Angiographic and clinical definitions of MI type are discordant in a substantial proportion of patients. Clinical triggers are associated with all-cause mortality. Predictive performance of GRACE score is worse in T2MI patients.
动脉血栓形成是 1 型（T1）心肌梗死（MI）的主要机制，而 2 型（T2）MI 通常在存在诱因（贫血、心律失常等）的情况下诊断。我们旨在评估基于血管造影和临床定义的 T1 与 T2 MI 的比例、它们的一致性和预后。
连续接受冠状动脉造影检查的 MI 患者[n=712，61%为男性；年龄 64.6±12.3 岁]根据动脉血栓形成和可识别的诱因进行分类。评估血管造影和临床 MI 类型标准与不良结局（随访时间为 1.5 年）之间的关联。然后评估 GRACE 风险评分对全因死亡率的预测能力。
在 397 例（55.6%）和 324 例（45.5%）患者中分别发现动脉血栓形成和临床诱因。只有 247 例（34.7%）患者存在“真正”T1MI（动脉血栓形成+/触发-）；174 例（24.4%）被诊断为“真正”T2MI（动脉血栓形成-/触发+），而 291 例（40.9%）存在临床和血管造影特征不一致。T2MI（20.1%）患者的全因死亡率高于 T1MI（9.3%）， = 0.002。存在诱因[比值比（OR）2.4，95%置信区间（CI）1.5-3.6，<0.0001]而不是动脉血栓形成[OR 0.8，95%CI 0.5-1.3，=0.26]与预后不良相关。GRACE 评分在 T1MI 中比 T2MI 更能预测死亡：曲线下面积 0.893（95%CI 0.830-0.956）vs 0.748（95%CI 0.652-0.843）， = 0.013。
在相当一部分患者中，MI 类型的血管造影和临床定义不一致。临床诱因与全因死亡率相关。GRACE 评分在 T2MI 患者中的预测性能较差。
