Abstract
While prognoses in relation to myocardial infarction (MI) type have been elucidated in past reports, the results were not consistent, perhaps due to occurrence of Type 2 MI with CVS and its mortality. The Japanese registry of acute Myocardial Infarction diagnosed by Universal Definition (J-MINUET) is a prospective multicenter registry in Japan. In contrast to thromboembolic event-related Type 1 myocardial infarction (MI), clinical features of Type 2 MI, including coronary vasospasm (CVS), are varied due to the heterogeneous nature of its development. To elucidate the MI type-related all-cause mortality, 2989 consecutive patients with AMI were stratified as Type 1 MI, Type 2 MI with CVS, and Type 2 MI with non-CVS. Most patients (n = 2834; 94.8%) were classified as Type 1 MI and 155 patients (5.2%) were classified as Type 2 MI. Of the Type 2 MI patients, 87 (56% of Type 2 MI) were diagnosed as MI with CVS. Although the 3-year mortality was comparable between Type 1 and Type 2 MI patients, significant differences were observed between Type 2 MI with CVS and with non-CVS (3.4% and 22.1%, p < 0.001). Among Japanese patients with AMI, mortality rates between Type 1 MI and Type 2 MI are comparable, but further stratification of Type 2 MI (with or without CVS) may be useful in predicting the prognosis of patients with Type 2 MI.
Highlights
The principle of the European Society of Cardiology (ESC)/ACC document published in 2000 regarding the redefinition of myocardial infarction (MI) was that myocardial damage detected by abnormal cardiac biomarkers [preferably cardiac troponin] during acute myocardial ischemia should be labeled as MI [1]
In terms of coronary risk factors, the incidence of diabetes mellitus (DM) was higher whereas dyslipidemia was lower in the Type 1 MI group
There was no significant difference between the two groups in the presence of chronic kidney disease (CKD) and current smoking
Summary
The principle of the ESC/ACC document published in 2000 regarding the redefinition of myocardial infarction (MI) was that myocardial damage detected by abnormal cardiac biomarkers [preferably cardiac troponin (cTn)] during acute myocardial ischemia should be labeled as MI [1]. After the third UDMI in 2012, included a correction related to patients undergoing coronary interventions [3], the fourth UDMI in 2018 was required for several reasons, including the predominance of high sensitivity cTn assays. Coronary vasospasm (CVS) is one of the causes of MI, including Type 2 MI. None of these studies examined the prognostic impact of CVS. We hypothesized that prognosis may vary among patients with the heterogeneous clinical features of Type 2 MI, especially in patients with CVS-related Type 2 MI. Further stratification of Type 2 MI patients by presence or absence of CVS and subsequent related clinical outcomes may offer insights for improvement in patient care
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