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Original research
Acute versus chronic myocardial injury and long-term outcomes
  1. Erik Kadesjö1,
  2. Andreas Roos1,
  3. Anwar Siddiqui1,
  4. Liyew Desta2,
  5. Magnus Lundbäck3,
  6. Martin J Holzmann1
  1. 1 Functional Area of Emergency Medicine, Karolinska University Hospital, 14184, Stockholm
  2. 2 Heart and Vascular Theme, Functional Area of Ischemic Heart Disease, Karolinska University Hospital, Huddinge, Stockholm, Sweden
  3. 3 Department of Clinical Sciences, Division of CardiovascularMedicine, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Martin J Holzmann, Functional Area of Emergency Medicine, Karolinska Universitetssjukhuset, Huddinge, 14186, Stockholm, Sweden; martin.holzmann{at}


Objective There is a paucity of data regarding prognosis in patients with acute versus chronic myocardial injury for long-term outcomes. We hypothesised that patients with chronic myocardial injury have a similar long-term prognosis as patients with acute myocardial injury.

Methods In an observational cohort study of 22 589 patients who had high-sensitivity cardiac troponin T (hs-cTnT) measured in the emergency department during 2011–2014, we identified all patients with level >14 ng/L and categorised them as acute myocardial injury, type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI) or chronic myocardial injury through adjudication. We estimated adjusted HRs with 95% CIs for the primary outcome all-cause mortality and secondary outcomes MI, and heart failure in patients with acute myocardial injury, T1MI and T2MI compared with chronic myocardial injury.

Results In total, 3853 patients were included. During 3.9 (±2) years of follow-up, 48%, 24%, 44% and 49% of patients with acute myocardial injury, T1MI, T2MI and chronic myocardial injury died, respectively. Patients with acute myocardial injury had higher adjusted risks of death (1.21, 95% CI 1.08 to 1.36) and heart failure (1.24, 95% CI 1.07 to 1.43), but a similar risk for myocardial infarction (MI) compared with the reference group. Patients with T1MI had a lower adjusted risk of death (0.86, 95% CI 0.74 to 1.00) and higher risk of MI (2.09, 95% CI 1.62 to 2.68), but a similar risk of heart failure. Patients with T2MI had a higher adjusted risk of death (1.46, 95% CI 1.18 to 1.80) and heart failure (1.30, 95% CI 1.00 to 1.69) compared with patients with chronic myocardial injury.

Conclusions Absolute long-term risks for death are similar, and adjusted risks are slightly higher, among patients with acute myocardial injury and T2MI, respectively, compared with chronic myocardial injury. The lowest risk of long-term mortality was found in patients with T1MI. Both acute and chronic myocardial injury are associated with very high risks of adverse outcomes.

  • coronary artery disease
  • epidemiology
  • cardiac risk factors and prevention

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  • Contributors Study concept and design: all authors. Acquisition of data: MJH. Analysis and interpretation of data: all authors. Drafting of the manuscript: EK and MJH. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: Fredrik Mattsson (external statistician).

  • Funding AR holds a research position funded by the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet (grant: 20160644). MJH holds research positions funded by the Swedish Heart-Lung Foundation (grant: 20170804) and the Stockholm County Council (grant: 20170686). The sponsors had no role in the design or conduct of this study.

  • Competing interests MJH received consultancy honoraria from Actelion, Idorsia and Pfizer. The remaining authors declare no conflicts of interest.

  • Ethics approval The study was approved by the regional Human Research Ethics Committee, Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.