TY - JOUR
T1 - Type 1 and 2 Myocardial Infarction and Myocardial Injury
T2 - Clinical Transition to High-Sensitivity Cardiac Troponin I
AU - Sandoval, Yader
AU - Smith, Stephen W.
AU - Sexter, Anne
AU - Thordsen, Sarah E.
AU - Bruen, Charles A.
AU - Carlson, Michelle D.
AU - Dodd, Kenneth W.
AU - Driver, Brian E.
AU - Hu, Yan
AU - Jacoby, Katherine
AU - Johnson, Benjamin K.
AU - Love, Sara A.
AU - Moore, Johanna C.
AU - Schulz, Karen
AU - Scott, Nathaniel L.
AU - Apple, Fred S.
N1 - Funding Information:
Funding: The UTROPIA study (NCT02060760) was partially funded through a grant from 1) Abbott Diagnostics, who had no role in the design and conduction of the study; including data collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the final manuscript; and b) the Minneapolis Medical Research Foundation.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/12
Y1 - 2017/12
N2 - Background Studies addressing patients with type 2 myocardial infarction and myocardial injury, including the impact of using high-sensitivity (hs) cardiac troponin (cTn) assays on their incidence are needed. Methods Ours is a prospective, observational US cohort study. Consecutive emergency department patients with serial cTnI measurements were studied. Outcomes included 180-day mortality and major adverse cardiac events, including 2-year follow-up for those with myonecrosis. Results Among 1640 patients, using a contemporary cTnI assay, 30% (n = 497) had ≥1 cTnI >99th percentile, with 4.7% (n = 77), 8.5% (n = 140), and 17% (n = 280) classified as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Compared with patients without myonecrosis, 180-day mortality was higher for type 2 myocardial infarction (4% vs 13%, P <.0001) (adjusted hazard ratio 2.7; 95% confidence interval, 1.6-4.8; P =.0005) and myocardial injury (4% vs 11%, P <.0001) (adjusted hazard ratio 1.8; 95% confidence interval, 1.1-3.0; P =.02), both with mortality >20% at 2 years. Predictors of 2-year mortality for type 2 myocardial infarction included age, congestive heart failure, and beta-blockers. Relative to the contemporary cTnI assay, hs-cTnI had less myonecrosis (30% vs 26%, P =.003) and acute myocardial infarction (13.2% vs 10.8%, P =.032), including fewer type 2 myocardial infarctions (8.5% vs 6.3, P =.01), with no difference in myocardial injury (17% vs 15%, P =.1). Conclusions cTnI increases are encountered in approximately a third of patients, the majority due to nonatherothrombotic conditions. Compared with patients without myonecrosis, type 2 myocardial infarction and myocardial injury have worse short-term outcomes, with mortality rates >20% at 2 years. hs-cTnI assay does not lead to more myocardial injury or infarction.
AB - Background Studies addressing patients with type 2 myocardial infarction and myocardial injury, including the impact of using high-sensitivity (hs) cardiac troponin (cTn) assays on their incidence are needed. Methods Ours is a prospective, observational US cohort study. Consecutive emergency department patients with serial cTnI measurements were studied. Outcomes included 180-day mortality and major adverse cardiac events, including 2-year follow-up for those with myonecrosis. Results Among 1640 patients, using a contemporary cTnI assay, 30% (n = 497) had ≥1 cTnI >99th percentile, with 4.7% (n = 77), 8.5% (n = 140), and 17% (n = 280) classified as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Compared with patients without myonecrosis, 180-day mortality was higher for type 2 myocardial infarction (4% vs 13%, P <.0001) (adjusted hazard ratio 2.7; 95% confidence interval, 1.6-4.8; P =.0005) and myocardial injury (4% vs 11%, P <.0001) (adjusted hazard ratio 1.8; 95% confidence interval, 1.1-3.0; P =.02), both with mortality >20% at 2 years. Predictors of 2-year mortality for type 2 myocardial infarction included age, congestive heart failure, and beta-blockers. Relative to the contemporary cTnI assay, hs-cTnI had less myonecrosis (30% vs 26%, P =.003) and acute myocardial infarction (13.2% vs 10.8%, P =.032), including fewer type 2 myocardial infarctions (8.5% vs 6.3, P =.01), with no difference in myocardial injury (17% vs 15%, P =.1). Conclusions cTnI increases are encountered in approximately a third of patients, the majority due to nonatherothrombotic conditions. Compared with patients without myonecrosis, type 2 myocardial infarction and myocardial injury have worse short-term outcomes, with mortality rates >20% at 2 years. hs-cTnI assay does not lead to more myocardial injury or infarction.
KW - Cardiac troponin
KW - Myocardial infarction
KW - Myocardial injury
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U2 - 10.1016/j.amjmed.2017.05.049
DO - 10.1016/j.amjmed.2017.05.049
M3 - Article
C2 - 28739197
AN - SCOPUS:85027689487
SN - 0002-9343
VL - 130
SP - 1431-1439.e4
JO - American Journal of Medicine
JF - American Journal of Medicine
IS - 12
ER -
