Abstract
AimsWhilst the risk factors for type 1 myocardial infarction due to atherosclerotic plaque rupture and thrombosis are established, our understanding of the factors that predispose to type 2 myocardial infarction during acute illness is still emerging. Our aim was to evaluate and compare the risk factors for type 1 and type 2 myocardial infarction.Methods and resultsWe conducted a secondary analysis of a multi-centre randomized trial population of 48 282 consecutive patients attending hospital with suspected acute coronary syndrome. The diagnosis of myocardial infarction during the index presentation and all subsequent reattendances was adjudicated according to the Universal Definition of Myocardial Infarction. Cox regression was used to identify predictors of future type 1 and type 2 myocardial infarction during a 1-year follow-up period. Within 1 year, 1331 patients had a subsequent myocardial infarction, with 924 and 407 adjudicated as type 1 and type 2 myocardial infarction, respectively. Risk factors for type 1 and type 2 myocardial infarction were similar, with age, hyperlipidaemia, diabetes, abnormal renal function, and known coronary disease predictors for both (P < 0.05 for all). Whilst women accounted for a greater proportion of patients with type 2 as compared to type 1 myocardial infarction, after adjustment for other risk factors, sex was not a predictor of type 2 myocardial events [adjusted hazard ratio (aHR) 0.82, 95% confidence interval (CI) 0.66–1.01]. The strongest predictor of type 2 myocardial infarction was a prior history of type 2 events (aHR 6.18, 95% CI 4.70–8.12).ConclusionsRisk factors for coronary disease that are associated with type 1 myocardial infarction are also important predictors of type 2 events during acute illness. Treatment of these risk factors may reduce future risk of both type 1 and type 2 myocardial infarction.
Highlights
Myocardial infarction is a clinical diagnosis based on the presence of symptoms or signs of myocardial ischaemia in conjunction with acute myocardial injury, as indicated by a rise or fall in cardiac biomarker concentrations.[1]
Risk factors for coronary disease that are associated with type 1 myocardial infarction are important predictors of type 2 events during acute illness
Type 1 myocardial infarction occurs in those with atherosclerotic plaque rupture and thrombosis, whereas type 2 myocardial infarction occurs due to myocardial oxygen supply and demand imbalance in the context of an acute illness causing tachyarrhythmia, hypoxia, or hypotension without acute atherothrombosis
Summary
Myocardial infarction is a clinical diagnosis based on the presence of symptoms or signs of myocardial ischaemia in conjunction with acute myocardial injury, as indicated by a rise or fall in cardiac biomarker concentrations.[1] The Fourth Universal Definition recognizes that myocardial infarction can result from a number of different pathophysiological mechanisms.[1,2,3] Type 1 myocardial infarction occurs in those with atherosclerotic plaque rupture and thrombosis, whereas type 2 myocardial infarction occurs due to myocardial oxygen supply and demand imbalance in the context of an acute illness causing tachyarrhythmia, hypoxia, or hypotension without acute atherothrombosis. Risk factors that predict type 2 myocardial infarction are likely to be more complex, with an acute illness responsible for supply or demand imbalance and myocardial infarction in a population of susceptible patients. Or demand imbalance itself is often multifactorial and may arise from any acute process leading to sustained tachycardia, hypoxia, or hypotension. Type 2 myocardial infarction is not ubiquitous during acute illness, and some patients may tolerate significant haemodynamic stress without cardiac consequence (Graphical Abstract)
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