Abstract
Purpose: We determined clinical outcomes according to type1 and 2 myocardial infarction (MI) of the third universal definition. Methods: A total of 5,355 patients were categorized into the type 1 and 2 MI. Type 1 MI was defined when culprit lesion had >70% diameter stenosis (DS) with visible thrombus and distal TIMI flow grade 0 through 2 and type 2 MI when the lesion had ≤70% DS with TIMI flow grade 3 and no thrombus. Primary outcome was the composite of major adverse cardiac events (MACE, defined as death, MI, or revascularization) at one-year. Results: Type 1 MI was in 3,952 (73.8%) patients and type 2 MI 1,403 (26.2%). STEMI was more in type 1 MI (68.4 vs. 41.2%, p<0.0001). Type 1 MI had more Killip class III or IV (14.8 vs. 11.0%, p<0.0001), higher peak troponin I (25.0 vs. 6.4 ng/mL, p<0.001), and higher use of glycoprotein IIb/IIIa inhibitors (27.5 vs. 11.6%, p<0.0001). In-hospital mortality was significantly higher in type 1 MI (4.6 vs. 2.6%, p=0.002). At one-year, death and the composite of MACE were significantly higher in type 1 MI (7.1 vs. 4.8%, p=0.004; 12.1 vs. 9.8%, p=0.025, respectively). By multivariable analysis, baseline TIMI flow grade was an independent predictor of death (HR 0.866, 95% CI 0.786-0.955, p=0.004) and the composite of MACE (HR 0.913, 95% CI 0.851-0.980, p=0.012) at one-year. In Kaplan-Meier curve, the cumulative survival was significantly better in type 2 MI (log rank p=0.025). ![Figure][1] Kaplan-Meier curve Conclusions: Patients with type 2 MI was in 26.2% of patients in this prospective registry and showed better clinical outcomes than patients with type 1 MI. Baseline TIMI flow grade was associated with death and the composite of MACE at one-year. This study implies that the third universal definition of MI should be incorporated in clinical trials to clarify prognosis more accurately. [1]: pending:yes
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