TY - JOUR
T1 - Provoking conditions, management and outcomes of type 2 myocardial infarction and myocardial necrosis
AU - Smilowitz, Nathaniel R.
AU - Weiss, Matthew C.
AU - Mauricio, Rina
AU - Mahajan, Asha M.
AU - Dugan, Kaitlyn E.
AU - Devanabanda, Arvind
AU - Pulgarin, Claudia
AU - Gianos, Eugenia
AU - Shah, Binita
AU - Sedlis, Steven P.
AU - Radford, Martha
AU - Reynolds, Harmony R.
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Background Type 2 myocardial infarction (MI) is defined as myocardial necrosis (myonecrosis) due to an imbalance in supply and demand with clinical evidence of ischemia. Some clinical scenarios of supply-demand mismatch predispose to myonecrosis but limit the identification of symptoms and ECG changes referable to ischemia; therefore, the MI definition may not be met. Factors that predispose to type 2 MI and myonecrosis without definite MI, approaches to treatment, and outcomes remain poorly characterized. Methods Patients admitted to an academic medical center with an ICD-9 diagnosis of secondary myocardial ischemia or non-primary diagnosis of non-ST-elevation MI were retrospectively reviewed. Cases were classified as either MI (n = 255) or myonecrosis without definite MI (n = 220) based on reported symptoms, ischemic ECG changes, and new wall motion abnormalities. Results Conditions associated with type 2 MI or myonecrosis included non-cardiac surgery (38%), anemia or bleeding requiring transfusion (32%), sepsis (31%), tachyarrhythmia (23%), hypotension (22%), respiratory failure (23%), and severe hypertension (8%). Inpatient mortality was 5%, with no difference between patients with MI and those with myonecrosis (6% vs. 5%, p = 0.41). At discharge, only 43% of patients received aspirin and statin therapy. Conclusions Type 2 MI and myonecrosis occur frequently in the setting of supply-demand mismatch due to non-cardiac surgery, sepsis, or anemia. Myonecrosis without definite MI is associated with similar in-hospital mortality as type 2 MI; both groups warrant further workup for cardiovascular disease. Antiplatelet and statin prescriptions were infrequent at discharge, reflecting physician uncertainty about the role of secondary prevention in these patients.
AB - Background Type 2 myocardial infarction (MI) is defined as myocardial necrosis (myonecrosis) due to an imbalance in supply and demand with clinical evidence of ischemia. Some clinical scenarios of supply-demand mismatch predispose to myonecrosis but limit the identification of symptoms and ECG changes referable to ischemia; therefore, the MI definition may not be met. Factors that predispose to type 2 MI and myonecrosis without definite MI, approaches to treatment, and outcomes remain poorly characterized. Methods Patients admitted to an academic medical center with an ICD-9 diagnosis of secondary myocardial ischemia or non-primary diagnosis of non-ST-elevation MI were retrospectively reviewed. Cases were classified as either MI (n = 255) or myonecrosis without definite MI (n = 220) based on reported symptoms, ischemic ECG changes, and new wall motion abnormalities. Results Conditions associated with type 2 MI or myonecrosis included non-cardiac surgery (38%), anemia or bleeding requiring transfusion (32%), sepsis (31%), tachyarrhythmia (23%), hypotension (22%), respiratory failure (23%), and severe hypertension (8%). Inpatient mortality was 5%, with no difference between patients with MI and those with myonecrosis (6% vs. 5%, p = 0.41). At discharge, only 43% of patients received aspirin and statin therapy. Conclusions Type 2 MI and myonecrosis occur frequently in the setting of supply-demand mismatch due to non-cardiac surgery, sepsis, or anemia. Myonecrosis without definite MI is associated with similar in-hospital mortality as type 2 MI; both groups warrant further workup for cardiovascular disease. Antiplatelet and statin prescriptions were infrequent at discharge, reflecting physician uncertainty about the role of secondary prevention in these patients.
KW - Myocardial infarction
KW - Myocardial injury
KW - Myocardial ischemia
KW - Myocardial necrosis
KW - Risk factor
KW - Secondary prevention
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U2 - 10.1016/j.ijcard.2016.05.045
DO - 10.1016/j.ijcard.2016.05.045
M3 - Article
C2 - 27236114
AN - SCOPUS:84969949614
SN - 0167-5273
VL - 218
SP - 196
EP - 201
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -