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Type 2 myocardial infarction in clinical practice
  1. Tomasz Baron1,
  2. Kristina Hambraeus2,
  3. Johan Sundström1,
  4. David Erlinge3,
  5. Tomas Jernberg4,
  6. Bertil Lindahl1,
  7. TOTAL-AMI study group
  1. 1Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
  2. 2Department of Cardiology, Falun Hospital, Falun, Sweden
  3. 3Department of Cardiology, Lund University, Skane University Hospital, Lund, Sweden
  4. 4Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
  1. Correspondence to Dr Tomasz Baron, Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Dag Hammarskjölds väg 14B, 1 tr, Uppsala 752 37, Sweden; tomasz.baron{at}ucr.uu.se

Abstract

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.

  • MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)

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