Department of Cardiology, Uppsala Universitet, Uppsala, Sweden
Department of Cardiology, Uppsala Universitet, Uppsala, Sweden.
Heart. 2023 Sep 28;109(20):1533-1541. doi: 10.1136/heartjnl-2022-322298.
Type 2 myocardial infarction (MI) and myocardial injury are common conditions associated with an adverse prognosis. Physicians experience uncertainty how to distinguish these conditions, as well as how to manage and treat them. Therefore, the objective of this study was to compare treatment and prognosis in patients with an adjudicated diagnosis of type 2 MI and myocardial injury, who were discharged with and without a clinical diagnosis of MI.
The study consisted of two cohorts, 964 and 281 consecutive patients with elevated cardiac troponin, discharged with and without a clinical diagnosis of MI, respectively. All cases were adjudicated into MI type 1-5 or myocardial injury and followed regarding all-cause death.
The adjudication identified 138 and 37 cases of type 2 MI, and 86 and 185 of myocardial injury, with and without a clinical MI diagnosis, respectively. In patients with type 2 MI, a clinical MI diagnosis was associated with more coronary angiography investigations (39.1% vs 5.4%, p<0.001) and an increased use of secondary prevention medications (all p<0.001). However, no difference was observed in adjusted 5-year mortality between patients with and without a clinical MI diagnosis (HR: 0.77 with 95% CI 0.43 to 1.38). The results were similar for adjudicated myocardial injury.
In both type 2 MI and myocardial injury, a clinical diagnosis of MI at discharge was associated with more investigations and treatments. However, no prognostic effect of receiving a clinical MI diagnosis was observed.
2 型心肌梗死（MI）和心肌损伤是常见的预后不良的病症。医生在如何区分这些病症，以及如何管理和治疗这些病症方面存在不确定性。因此，本研究的目的是比较经判定患有 2 型 MI 和心肌损伤并出院的患者，在有无临床 MI 诊断的情况下的治疗和预后。
本研究包括两个队列，分别为 964 例和 281 例连续因心肌肌钙蛋白升高而出院的患者，他们分别有和没有临床 MI 诊断。所有病例均被判定为 MI 1 型至 5 型或心肌损伤，并进行全因死亡率随访。
判定结果为，有临床 MI 诊断的患者中 138 例为 2 型 MI，37 例为心肌损伤，无临床 MI 诊断的患者中 86 例为 2 型 MI，185 例为心肌损伤。在 2 型 MI 患者中，有临床 MI 诊断与更多的冠状动脉造影检查（39.1%比 5.4%，p<0.001）和更多的二级预防药物使用相关（均 p<0.001）。然而，有和无临床 MI 诊断的患者在调整后的 5 年死亡率方面无差异（HR：0.77，95%CI 0.43 至 1.38）。判定为心肌损伤的结果也类似。
在 2 型 MI 和心肌损伤中，出院时的临床 MI 诊断与更多的检查和治疗相关。然而，并未观察到接受临床 MI 诊断的预后效果。
