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Journal Club 12 November 2014

Paper

Type 2 myocardial infarction in clinical practice

Presenter

KL

Summary

Objective

We aimed to assess differences in incidence,
clinical features, current treatment strategies and
outcome in patients with type 2 vs. type 1 acute
myocardial infarction (AMI).

Methods and results

All 20 138 hospitalisations in
Sweden with a diagnosis of AMI registered during 2011
in the Swedish Web-system for Enhancement and
Development of Evidence-based care in Heart disease
Evaluated According to Recommended Therapies were
classified into types 1–5 in accordance with the
universal definition of myocardial infarction (MI) from
2007. Type 1 AMI was present in 88.5% of the cases
while 7.1% were classified as type 2 AMI. Higher age,
female sex, comorbidities, impaired renal function,
anaemia and smaller extent of myocardial necrosis
characterised patients with type 2 AMI. While normal
coronary arteries were more frequently seen (42.4% vs.
7.4%), an invasive treatment was less common, and
antiplatelet medications were less prescribed in patients
with type 2 AMI compared with type 1 AMI. The group
with type 2 AMI had significantly higher crude 1-year
mortality compared with the group with type 1 AMI
(24.7% vs. 13.5%, p<0.001). However, after
adjustment, the HR for 1-year mortality in patients with
type 2 AMI was 1.03 (95% CI 0.86 to 1.23).

Conclusions

In this real-life study, 7.1% of myocardial
infarctions were classified as type 2 AMI. These patients
were older, predominantly women and had more
comorbidities. Invasive treatment strategies and
cardioprotective medications were less used. Patients
with type 2 AMI had higher crude mortality compared
with type 1 patients with MI. However, after adjustment,
the 1-year mortality was similar.

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