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Comparative Study
. 2021 Feb 23;77(7):848-857.
doi: 10.1016/j.jacc.2020.12.034.

Patient Characteristics and Clinical Outcomes of Type 1 Versus Type 2 Myocardial Infarction

Cian P McCarthy  1 , Dhaval Kolte  1 , Kevin F Kennedy  2 , Muthiah Vaduganathan  3 , Jason H Wasfy  1 , James L Januzzi Jr  4
Affiliations
Free article
Comparative Study

Patient Characteristics and Clinical Outcomes of Type 1 Versus Type 2 Myocardial Infarction

Cian P McCarthy et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Type 2 myocardial infarction (MI) patients may have different characteristics and outcomes when compared with type 1 MI.

Objectives: The purpose of this study was to compare patients with type 1 MI to those with type 2 MI in the United States.

Methods: Using the Nationwide Readmissions Database, MI patients were categorized over the 3 months following the introduction of an International Classification of Diseases-10th Revision code specific for type 2 MI. Baseline characteristics and inpatient and post-discharge outcomes among both cohorts were compared.

Results: There were 216,657 patients with type 1 MI, 37,765 patients with type 2 MI, and 1,525 patients with both type 1 and 2 MI. Patients with type 2 MI were older (71 years vs. 69 years; p < 0.001), were more likely to be women (47.3% vs. 40%; p < 0.001), and had higher prevalence of heart failure (27.9% vs. 10.9%; p < 0.001), kidney disease (35.7% vs. 25.7%; p < 0.001), and atrial fibrillation (31% vs. 21%; p < 0.001). Rates of coronary angiography (10.9% vs. 57.3%; p < 0.001), percutaneous coronary intervention (1.7% vs. 38.5%; p < 0.001), and coronary artery bypass grafting (0.4% vs. 7.8%; p < 0.001) were lower among type 2 MI patients. Patients with type 2 MI had lower risk of in-hospital mortality (adjusted odds ratio: 0.57 [95% confidence interval: 0.54 to 0.60]) and 30-day MI readmission (adjusted odds ratio: 0.46 [95% confidence interval: 0.35 to 0.59]). There was no difference in risk of 30-day all-cause or heart failure readmission.

Conclusions: Patients with type 2 MI have a unique cardiovascular phenotype when compared with type 1 MI, and are managed in a heterogenous manner. Validated management strategies for type 2 MI are needed.

Keywords: Nationwide Readmissions Database; outcomes; type 2 myocardial infarction.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (National Institutes of Health/National Center for Advancing Translational Sciences Award UL 1TR002541); has served on advisory boards for Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa; has received grant support from Amgen; and has participated on clinical endpoint committees for studies sponsored by Galmed, Novartis, and the NIH. Dr. Wasfy has received a grant from the American Heart Association (18 CDA 34110215); has received consulting fees from Pfizer and Biotronik; has served as vice-chair of New England CEPAC; and has received reimbursements for travel from nonprofit professional and academic organizations. Dr. Januzzi is supported in part by the Hutter Family Professorship; is a Trustee of the American College of Cardiology; has received grant support from Novartis Pharmaceuticals, Innolife, Applied Therapeutics, and Abbott Diagnostics; has received consulting income from Abbott, Janssen, Novartis, Pfizer, Merck, and Roche Diagnostics; and has participated in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Bayer, CVRx, and Takeda. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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