In the Journals

Type 2 MI common, associated with poor outcomes in patients undergoing angiography

More than 12% of a cohort of patients undergoing PCI or peripheral artery angiography had type 2 MI, and it was often recurrent, according to results from the CASABLANCA study.

Hanna K. Gaggin, MD, MPH, FACC, a cardiologist at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, and colleagues prospectively analyzed 1,251 patients from Massachusetts General Hospital who underwent coronary or peripheral angiography with or without intervention.

Hanna K. Gaggin

The primary outcome was type 2 MI. Other outcomes of interest included type 1 MI and MACE, defined as all-cause death, nonfatal MI, HF, stroke, transient ischemic attack, peripheral artery complication and cardiac arrhythmia.

The findings were initially presented in April 2016 at the American College of Cardiology Scientific Session and are now published in Circulation.

During a median follow-up of 3.4 years, 12.2% of patients had type 2 MI, and it recurred frequently, Gaggin and colleagues wrote.

The researchers determined the following predictors of type 2 MI: older age, lower systolic BP, diabetes, nitrate use, elevated glucose, elevated N-terminal pro–B-type natriuretic peptide and elevated cystatin C.

Compared with those who did not have type 2 MI, patients with type 2 MI had higher subsequent rates of MACE (53.7 per 100 person-years vs. 21.1 per 100 person-years; P < .001), all-cause mortality (23.3 per 100 person-years vs. 3.3 per 100 person-years; P < .001), CV death (17.5 per 100 person-years vs. 2.6 per 100 person-years; P < .001) and HF events (22.4 per 100 person-years vs. 7.4 per 100 person-years; P < .001), according to the researchers.

The rates of subsequent events in patients with type 2 MI were similar to those in patients with type 1 MI, Gaggin and colleagues wrote.

A diagnosis of type 2 MI predicted risk for later MACE (adjusted HR = 1.9; 95% CI, 1.46-2.48), all-cause mortality (adjusted HR = 2.96; 95% CI, 2.01-4.36) and CV death (adjusted HR = 2.16; 95% CI, 1.36-3.43), according to the researchers.

In the cohort, “incident [type 2] MI was common and closely associated with poor prognosis,” Gaggin and colleagues wrote. “Prediction of future [type 2] MI may be possible. Our study suggests that those with [type 2] MI represent a morbid population of patients in need of multidisciplinary care to reduce their considerable [CV] and medical risk. Prospective randomized trials comparing the effectiveness of treatment strategies for [type 2] MI are needed.” – by Erik Swain

Disclosure: The study was sponsored in part by Siemens Diagnostics. Gaggin reports financial ties with American Regent, Amgen, Boston Heart Diagnostics, EchoSense, Ortho Clinical, Portola, Radiometer and Roche Diagnostics. Please see the full study for a list of the other researchers’ relevant financial disclosures.

 

 

More than 12% of a cohort of patients undergoing PCI or peripheral artery angiography had type 2 MI, and it was often recurrent, according to results from the CASABLANCA study.

Hanna K. Gaggin, MD, MPH, FACC, a cardiologist at Massachusetts General Hospital and assistant professor of medicine at Harvard Medical School, and colleagues prospectively analyzed 1,251 patients from Massachusetts General Hospital who underwent coronary or peripheral angiography with or without intervention.

Hanna K. Gaggin

The primary outcome was type 2 MI. Other outcomes of interest included type 1 MI and MACE, defined as all-cause death, nonfatal MI, HF, stroke, transient ischemic attack, peripheral artery complication and cardiac arrhythmia.

The findings were initially presented in April 2016 at the American College of Cardiology Scientific Session and are now published in Circulation.

During a median follow-up of 3.4 years, 12.2% of patients had type 2 MI, and it recurred frequently, Gaggin and colleagues wrote.

The researchers determined the following predictors of type 2 MI: older age, lower systolic BP, diabetes, nitrate use, elevated glucose, elevated N-terminal pro–B-type natriuretic peptide and elevated cystatin C.

Compared with those who did not have type 2 MI, patients with type 2 MI had higher subsequent rates of MACE (53.7 per 100 person-years vs. 21.1 per 100 person-years; P < .001), all-cause mortality (23.3 per 100 person-years vs. 3.3 per 100 person-years; P < .001), CV death (17.5 per 100 person-years vs. 2.6 per 100 person-years; P < .001) and HF events (22.4 per 100 person-years vs. 7.4 per 100 person-years; P < .001), according to the researchers.

The rates of subsequent events in patients with type 2 MI were similar to those in patients with type 1 MI, Gaggin and colleagues wrote.

A diagnosis of type 2 MI predicted risk for later MACE (adjusted HR = 1.9; 95% CI, 1.46-2.48), all-cause mortality (adjusted HR = 2.96; 95% CI, 2.01-4.36) and CV death (adjusted HR = 2.16; 95% CI, 1.36-3.43), according to the researchers.

In the cohort, “incident [type 2] MI was common and closely associated with poor prognosis,” Gaggin and colleagues wrote. “Prediction of future [type 2] MI may be possible. Our study suggests that those with [type 2] MI represent a morbid population of patients in need of multidisciplinary care to reduce their considerable [CV] and medical risk. Prospective randomized trials comparing the effectiveness of treatment strategies for [type 2] MI are needed.” – by Erik Swain

Disclosure: The study was sponsored in part by Siemens Diagnostics. Gaggin reports financial ties with American Regent, Amgen, Boston Heart Diagnostics, EchoSense, Ortho Clinical, Portola, Radiometer and Roche Diagnostics. Please see the full study for a list of the other researchers’ relevant financial disclosures.

 

 

    See more from Myocardial Infarction Resource Center