Haller Paul M, Kellner Caroline, Sörensen Nils A, Lehmacher Jonas, Toprak Betül, Schock Alina, Hartikainen Tau S, Twerenbold Raphael, Zeller Tanja, Westermann Dirk, Neumann Johannes T
Department of Cardiology, University Heart and Vascular Center Hamburg, Center for Population Health Innovation (POINT), University Medical Center Hamburg-Eppendorf, Building O50, Empore, Martinistrasse 52, 20246, Hamburg, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.
Clin Res Cardiol. 2025 Jun;114(6):700-708. doi: 10.1007/s00392-023-02334-w. Epub 2023 Nov 20.
Patients with acute or chronic myocardial injury are frequently identified in the context of suspected myocardial infarction (MI). We aimed to investigate their long-term follow-up.
We prospectively enrolled 2714 patients with suspected MI and followed them for all-cause mortality and a composite cardiovascular endpoint (CVE; cardiovascular death, MI, unplanned revascularization) for a median of 5.1 years. Final diagnoses were adjudicated by two cardiologists according to the Fourth Universal Definition of MI, including 143 (5.3%) ST-elevation MI, 236 (8.7%) non-ST-elevation MI (NSTEMI) Type 1 (T1), 128 (4.7%) NSTEMI T2, 86 (3.2%) acute and 677 (24.9%) with chronic myocardial injury, and 1444 (53.2%) with other reasons for chest pain (reference). Crude event rates per 1000 patient-years for all-cause mortality were highest in patients with myocardial injury (81.6 [71.7, 92.3]), and any type of MI (55.9 [46.3, 66.7]), compared to reference (12.2 [9.8, 15.1]). Upon adjustment, all diagnoses were significantly associated with all-cause mortality. Moreover, patients with acute (adj-HR 1.92 [1.08, 3.43]) or chronic (adj-HR 1.59 [1.16, 2.18]) myocardial injury, and patients with NSTEMI T1 (adj-HR 2.62 [1.85, 3.69]) and ST-elevation MI (adj-HR 3.66 [2.41, 5.57]) were at increased risk for cardiovascular events.
Patients with myocardial injury are at a similar increased risk for death and cardiovascular events compared to patients with acute MI. Further studies need to determine appropriate management strategies for patients with myocardial injury.
Clinicaltrials.gov (NCT02355457).
急性或慢性心肌损伤患者常在疑似心肌梗死（MI）的情况下被识别。我们旨在调查他们的长期随访情况。
我们前瞻性纳入了2714例疑似MI患者，并对他们进行全因死亡率和复合心血管终点（CVE；心血管死亡、MI、非计划血管重建）的随访，中位随访时间为5.1年。最终诊断由两位心脏病专家根据MI的第四版通用定义进行判定，包括143例（5.3%）ST段抬高型MI、236例（8.7%）1型非ST段抬高型MI（NSTEMI T1）、128例（4.7%）NSTEMI T2、86例（3.2%）急性和677例（24.9%）慢性心肌损伤，以及1444例（53.2%）因其他胸痛原因（参照组）。心肌损伤患者（81.6 [71.7, 92.3]）和任何类型MI患者（55.9 [46.3, 66.7]）的全因死亡率每1000患者年的粗事件发生率最高，而参照组为（12.2 [9.8, 15.1]）。经过调整后，所有诊断均与全因死亡率显著相关。此外，急性（校正风险比[adj-HR] 1.92 [1.08, 3.43]）或慢性（adj-HR 1.59 [1.16, 2.18]）心肌损伤患者，以及NSTEMI T1患者（adj-HR 2.62 [1.85, 3.69]）和ST段抬高型MI患者（adj-HR 3.66 [2.41, 5.57]）发生心血管事件的风险增加。
与急性MI患者相比，心肌损伤患者死亡和发生心血管事件的风险同样增加。需要进一步研究以确定心肌损伤患者的适当管理策略。
Clinicaltrials.gov（NCT02355457）。
