Cardiovascular Mortality After Type 1 and Type 2 Myocardial Infarction in Young Adults

Avinainder Singh, Ankur Gupta, Ersilia M. DeFilippis, Arman Qamar, David W. Biery, Zaid Almarzooq, Bradley Collins, Amber Fatima, Candace Jackson, Patrycja Galazka, Mattheus Ramsis, Daniel C. Pipilas, Sanjay Divakaran, Mary Cawley, Jon Hainer, Josh Klein, Petr Jarolim, Khurram Nasir, James L. Januzzi, Marcelo F. Di CarliDeepak L. Bhatt, Ron Blankstein

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


BACKGROUND: Type 2 myocardial infarction (MI) and myocardial injury are associated with increased short-term mortality. However, data regarding long-term mortality are lacking.

OBJECTIVES: This study compared long-term mortality among young adults with type 1 MI, type 2 MI, or myocardial injury.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Original languageEnglish (US)
Pages (from-to)1003-1013
Number of pages11
JournalJournal of the American College of Cardiology
Issue number9
StatePublished - Mar 10 2020


  • myocardial injury
  • outcomes
  • troponin
  • type 2 myocardial infarction
  • young adults
  • Humans
  • Middle Aged
  • Male
  • Massachusetts/epidemiology
  • Myocardial Infarction/classification
  • Adult
  • Female
  • Registries
  • Retrospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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