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. 2021 Sep 7;10(17):e020849.
doi: 10.1161/JAHA.121.020849. Epub 2021 Aug 21.

The Intersection of Type 2 Myocardial Infarction and Heart Failure

Cian P McCarthy  1 , Maeve Jones-O'Connor  2 , David S Olshan  2 , Sean Murphy  2 , Saad Rehman  2 , Joshua A Cohen  3 , Jinghan Cui  1 , Avinainder Singh  4 , Muthiah Vaduganathan  5 , James L Januzzi Jr  1 , Jason H Wasfy  1
Affiliations

The Intersection of Type 2 Myocardial Infarction and Heart Failure

Cian P McCarthy et al. J Am Heart Assoc. .

Abstract

Background Type 2 myocardial infarction (T2MI) is common and associated with high cardiovascular event rates. However, the relationship between T2MI and heart failure (HF) is uncertain. Methods and Results We identified patients with T2MI at a large tertiary hospital between October 2017 and May 2018. Patient characteristics, causes of T2MI, and subsequent HF hospitalizations were determined by physician chart review. We identified 359 patients with T2MI over the study period; 184 patients had a history of HF. Among patients with ejection fraction (EF) assessment (N=180), the majority had preserved EF (N=107; 59.4%), followed by reduced EF (N=54; 30.0%), and mid-range EF (N=19; 10.6%). Acute HF was the most common cause of T2MI (20.9%). Of those whose T2MI was precipitated by HF (N=75), the mean EF was 53.0±16.8% and 16 (21.3%) were de novo diagnoses of HF. Among patients with T2MI who were discharged alive with available follow-up (N=289), 5.5% were hospitalized with acute HF within 30 days, 17.3% within 180 days, and 22.1% within 1 year. In subgroup analyses, among patients with T2MI with prevalent or new HF (N=161), the rate of HF hospitalization at 1 year was 34.2%, considerably higher than those with T2MI and no HF diagnosis at discharge (7.0%; N=9/128). Conclusions Index presentations of HF or worsening chronic HF represent the most common causes of T2MI. ≈1 in 5 patients with T2MI will be readmitted for HF within 1 year of their event. Strategies to prevent HF events after a T2MI are needed.

Keywords: heart failure; outcomes; type 2 myocardial infarction.

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Conflict of interest statement

Dr Vaduganathan serves on advisory boards for Amgen, American Regent, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa, and participates on clinical endpoint committees for studies sponsored by Galmed, Novartis, and the NIH. Dr Januzzi is a Trustee of the American College of Cardiology and has received consulting income from Abbott, Janssen, Novartis, and Roche Diagnostics, and participates in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Janssen, Novartis and Takeda. The remaining authors have no disclosures to report.

Figures

Figure 1
Figure 1. Guideline‐directed medical therapy on admission among patients with type 2 MI with a history of heart failure with reduced ejection fraction (N=54).
ACEi indicates angiotensin‐converting‐enzyme inhibitor; ARB, angiotensin II receptor blocker; GDMT, guideline directed medical therapy; and MI, myocardial infarction.
Figure 2
Figure 2. Guideline‐directed medical therapy on discharge among patients with T2MI with a history of or newly diagnosed heart failure with reduced ejection fraction (N=50).
ACEI indicates angiotensin‐converting‐enzyme inhibitor; ARB, angiotensin II receptor blocker; GDMT, guideline directed medical therapy; and MI, myocardial infarction.
Figure 3
Figure 3. Kaplan‐Meier survival curves illustrating time‐to‐first HF hospitalization among (A) all patients with type 2 MI discharged alive with available follow‐up data at 1 year (N=289) and (B) patients with type 2 MI without a diagnosis of heart failure at discharge (N=128) vs those with a diagnosis of heart failure (N=161).
Presented with 95% pointwise CI calculated by log transformation. HF indicates heart failure; MI, myocardial infarction.
Figure 4
Figure 4. Kaplan‐Meier survival curves illustrating time‐to‐first HF hospitalization among patients with type 2 MI discharged alive with available follow‐up data at 1 year (N=289) and patients with myocardial injury (N=208).
Presented with 95% pointwise CIs calculated by log transformation. HF indicates heart failure; and MI, myocardial infarction.
Figure 5
Figure 5. Kaplan‐Meier survival curve illustrating time‐to‐first HF hospitalization or CV death among (A) all patients with type 2 MI discharged alive with available follow‐up data at 1 year (N=289) and (B) patients with type 2 MI without a diagnosis of heart failure at discharge (N=128) vs those who did (N=161).
Presented with 95% pointwise CIs calculated by log transformation. CV indicates cardiovascular; HF, heart failure; and MI, myocardial infarction.
Figure 6
Figure 6. Kaplan‐Meier survival curves illustrating time‐to‐first HF hospitalization or CV death among patients with type 2 MI discharged alive with available follow‐up data at 1 year (N=289) and patients with myocardial injury (N=208).
Presented with 95% pointwise CIs calculated by log transformation. CV indicates cardiovascular; HF, heart failure; and MI, myocardial infarction.
See this image and copyright information in PMC

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