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. 2020 Feb 24;2(3):118-128.
doi: 10.1016/j.cjco.2020.02.005. eCollection 2020 May.

Meta-analysis Comparing Outcomes of Type 2 Myocardial Infarction and Type 1 Myocardial Infarction With a Focus on Dual Antiplatelet Therapy

Christopher Reid  1 , Ahmed Alturki  2 , Andrew Yan  3 , Derek So  4 , Dennis Ko  5 , Jean-Francois Tanguay  6 , Amal Bessissow  7 , Shamir Mehta  8 , Shaun Goodman  3 , Thao Huynh  9
Affiliations

Meta-analysis Comparing Outcomes of Type 2 Myocardial Infarction and Type 1 Myocardial Infarction With a Focus on Dual Antiplatelet Therapy

Christopher Reid et al. CJC Open. .

Abstract
in English, French

Background: There are important knowledge gaps in type 2 myocardial infarction (T2MI). Our primary objective was to compare the outcomes of patients with T2MI with those of patients with type 1 myocardial infarction (T1MI). Our secondary objective was to determine whether randomized controlled trials (RCTs) evaluating dual antiplatelets (DAPTs) have explicitly included patients with T2MI.

Methods: We performed a meta-analysis comparing outcomes of patients with T2MI with patients with T1MI and a separate systematic review to evaluate the inclusion of T2MI in RCTs evaluating DAPT. There were 19 cohorts enrolling 48,829 patients (40,604 with T1MI and 5361 with T2MI) and 51 RCTs enrolling 188,132 patients with acute coronary syndrome.

Results: Patients with T2MI had approximately 2-fold increases in unadjusted odds of long-term mortality compared with patients with T1MI (odds ratio, 2.47; 95% confidence interval, 2.06-2.96; P < 0.0001) and a 45% increase in adjusted odds of long-term mortality (odds ratio, 1.45; 95% confidence interval, 1.25-1.69; P < 0.0001, respectively). There was no published evaluation of efficacy, effectiveness, and safety of DAPT in patients with T2MI.

Conclusion: Patients with T2MI are at increased risk of adjusted all-cause long-term mortality compared with patients with T1MI. The role of DAPT remains unclear in T2MI.

Contexte: Il existe d’importantes lacunes dans notre connaissance de l’infarctus du myocarde de type 2 (IMT2). Notre objectif principal était de comparer le devenir de patients ayant subi un IMT2 et celui de patients ayant subi un infarctus du myocarde de type 1 (IMT1). Notre objectif secondaire était de déterminer si des essais contrôlés randomisés (ECR) visant à évaluer des bithérapies antiplaquettaires (BA) avaient inclus explicitement des patients ayant subi un IMT2.

Méthodologie: Nous avons réalisé une méta-analyse afin de comparer le devenir de patients ayant subi un IMT2 et celui de patients ayant subi un IMT1. Nous avons aussi effectué une revue systématique distincte des données pour évaluer l’inclusion de cas d’IMT2 dans les ECR visant à évaluer des BA. Il y avait 19 cohortes regroupant 48 829 patients (40 604 ayant subi un IMT1 et 5 361 ayant subi un IMT2) et 51 ECR regroupant 188 132 patients atteints d’un syndrome coronarien aigu.

Résultats: Chez les patients ayant subi un IMT2, la probabilité non corrigée de mortalité à long terme était environ 2 fois plus élevée que chez les patients ayant subi un IMT1 (rapport de cotes : 2,47; intervalle de confiance à 95 % : 2,06-2,96; p < 0,0001), et la probabilité corrigée de mortalité à long terme était accrue de 45 % (rapport de cotes : 1,45; intervalle de confiance à 95 % : 1,25-1,69; p < 0,0001). Aucune évaluation de l’efficacité (potentielle ou réelle) et de l’innocuité des BA chez les patients ayant subi un IMT2 n’a été publiée.

Conclusion: Le risque corrigé de mortalité à long terme toutes causes confondues est plus élevé chez les patients ayant subi un IMT2 que chez les patients ayant subi un IMT1. Le rôle des BA reste à élucider dans les cas d’IMT2.

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Figures

Figure 1
Figure 1
Selection of studies. RCT, randomized controlled trial; T2MI, type 2 myocardial infarction.
Figure 2
Figure 2
Unadjusted comparison of long-term all-cause mortality. CI, confidence interval; T1MI, type 1 myocardial infarction; T2MI, type 2 myocardial infarction.
Figure 3
Figure 3
Adjusted comparison of long-term all-cause mortality. CI, confidence interval; HR, hazard ratio; T1MI, type 1 myocardial infarction; T2MI, type 2 myocardial infarction.
Figure 4
Figure 4
Funnel plot of adjusted comparison of all-cause mortality.
See this image and copyright information in PMC

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