TY - JOUR
T1 - Cardiovascular Mortality After Type 1 and Type 2 Myocardial Infarction in Young Adults
AU - Singh, Avinainder
AU - Gupta, Ankur
AU - DeFilippis, Ersilia M.
AU - Qamar, Arman
AU - Biery, David W.
AU - Almarzooq, Zaid
AU - Collins, Bradley
AU - Fatima, Amber
AU - Jackson, Candace
AU - Galazka, Patrycja
AU - Ramsis, Mattheus
AU - Pipilas, Daniel C.
AU - Divakaran, Sanjay
AU - Cawley, Mary
AU - Hainer, Jon
AU - Klein, Josh
AU - Jarolim, Petr
AU - Nasir, Khurram
AU - Januzzi, James L.
AU - Di Carli, Marcelo F.
AU - Bhatt, Deepak L.
AU - Blankstein, Ron
PY - 2020/3/10
Y1 - 2020/3/10
N2 - 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.
AB - 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.
KW - myocardial injury
KW - outcomes
KW - troponin
KW - type 2 myocardial infarction
KW - young adults
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UR - http://www.scopus.com/inward/citedby.url?scp=85079856343&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2019.12.052
DO - 10.1016/j.jacc.2019.12.052
M3 - Article
C2 - 32138959
AN - SCOPUS:85079856343
VL - 75
SP - 1003
EP - 1013
JO - Journal of the American College of Cardiology.
JF - Journal of the American College of Cardiology.
SN - 0735-1097
IS - 9
ER -