Author + information
- Received October 7, 2019
- Revision received December 15, 2019
- Accepted December 17, 2019
- Published online March 2, 2020.
- Avinainder Singh, MD, MMSca@AvinainderSingh,
- Ankur Gupta, MD, PhDb,
- Ersilia M. DeFilippis, MDc,
- Arman Qamar, MD, MPHb,
- David W. Biery, ABb,
- Zaid Almarzooq, MDb,
- Bradley Collins, MDb,
- Amber Fatima, MDd,
- Candace Jackson, MD, MPHe,
- Patrycja Galazka, MDb,
- Mattheus Ramsis, MDb,
- Daniel C. Pipilas, MDb,
- Sanjay Divakaran, MDb,
- Mary Cawley, BAb,
- Jon Hainer, BSb,
- Josh Klein, BSb,
- Petr Jarolim, MD, PhDf,
- Khurram Nasir, MD, MPHa,
- James L. Januzzi, MDg,
- Marcelo F. Di Carli, MDb,
- Deepak L. Bhatt, MD, MPHb@DLBhattMD and
- Ron Blankstein, MDb,∗ (, )@RonBlankstein
- aDepartment of Medicine, Yale University School of Medicine, New Haven, Connecticut
- bCardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
- cDepartment of Cardiology, Columbia University Medical Center, New York, New York
- dDepartment of Medicine, Tufts Medical Center, Boston, Massachusetts
- eDepartment of Medicine, Mayo Clinic, Rochester, Minnesota
- fDepartment of Pathology and Lab Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- gCardiovascular Division, Massachusetts General Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Ron Blankstein, Brigham & Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
Background Type 2 myocardial infarction (MI) and myocardial injury are associated with increased short-term mortality. However, data regarding long-term mortality are lacking.
Objectives This study compared long-term mortality among young adults with type 1 MI, type 2 MI, or myocardial injury.
Methods Adults age 50 years or younger who presented with troponin >99th percentile or the International Classification of Diseases code for MI over a 17-year period were identified. All cases were adjudicated as type 1 MI, type 2 MI, or myocardial injury based on the Fourth Universal Definition of MI. Cox proportional hazards models were constructed for survival free from all-cause and cardiovascular death.
Results The cohort consisted of 3,829 patients (median age 44 years; 30% women); 55% had type 1 MI, 32% had type 2 MI, and 13% had myocardial injury. Over a median follow-up of 10.2 years, mortality was highest for myocardial injury (45.6%), followed by type 2 MI (34.2%) and type 1 MI (12%) (p < 0.001). In an adjusted model, type 2 MI was associated with higher all-cause (hazard ratio: 1.8; 95% confidence interval: 1.2 to 2.7; p = 0.004) and cardiovascular mortality (hazard ratio: 2.7; 95% confidence interval: 1.4 to 5.1; p = 0.003) compared with type 1 MI. Those with type 2 MI or myocardial injury were younger and had fewer cardiovascular risk factors but had more noncardiovascular comorbidities. They were significantly less likely to be prescribed cardiovascular medications at discharge.
Conclusions Young patients who experience a type 2 MI have higher long-term all-cause and cardiovascular mortality than those who experience type 1 MI, with nearly one-half of patients with myocardial injury and more than one-third of patients with type 2 MI dying within 10 years. These findings emphasize the need to provide more aggressive secondary prevention for patients who experience type 2 MI and myocardial injury.
Drs. Divakaran and Gupta are supported by a T32 postdoctoral training grant from the National Heart, Lung, and Blood Institute (T32 HL094301). Dr. Jarolim has received research support from Abbott Laboratories, AstraZeneca, Daiichi-Sankyo, GlaxoSmithKline, Merck, Roche Diagnostics, Takeda Global Research and Development Center, and Waters Technologies Corporation; and has been a member of the Scientific Advisory Board for Roche Diagnostics. Dr. Di Carli has received research grants from Gilead Sciences and Spectrum Dynamics. Dr. Bhatt has served on the Advisory Board for Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, and Regado Biosciences; has served on the Board of Directors for Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; has served as Chair of the American Heart Association Quality Oversight Committee; has served on Data Monitoring Committees for Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi-Sankyo), and the Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has served as Deputy Editor of Clinical Cardiology, NCDR-ACTION Registry Steering Committee (Chair), and VA CART Research and Publications Committee (Chair); has received research funding from Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has been a site co-investigator for Biotronik, Boston Scientific, St. Jude Medical (now Abbott), and Svelte; is a trustee for the American College of Cardiology; and has received unfunded research from FlowCo, Fractyl, Merck, Novo Nordisk, PLx Pharma, and Takeda. Dr. Blankstein has received research support from Amgen Inc. and Astellas Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Harvey White, MBChB, DSc, FRACP served as guest associate editor for this paper.
- Received October 7, 2019.
- Revision received December 15, 2019.
- Accepted December 17, 2019.
- 2020 American College of Cardiology Foundation
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