Type 2 MI confers elevated risk for death within 1-year follow-up
PHILADELPHIA — Patients with type 2 MI are at greater risk for recurrent CV events and death within the first year of follow-up compared with patients experiencing type 1 MI, according to findings presented at the American Heart Association Scientific Sessions.
In a meta-analysis including the TRACER, EUCLID and EXSCEL trials data, researchers found that overall, a higher proportion of patients experienced a type 1 MI (n = 1,822; 73%) than type 2 (n = 646; 27%) after being included in one of the trials.
Compared with patients experiencing type 1 MI, those who had type 2 MI were older, more frequently black and more likely to have hypertension and dyslipidemia. In addition, patients with type 2 MI also had higher prevalence of preexisting CV conditions including congestive HF, atrial fibrillation or prior stroke compared with patients with type 1 MI.
Researchers also found that patients who experienced type 2 MIs first tended to have a higher rate of subsequent clinical outcomes (MI, 18.43 per 100 patient-years; 95% CI, 15.53-21.87; CV mortality, 12.06 per 100 patient-years; 95% CI, 9.92-14.68; all-cause mortality, 26.54 per 100 patient-years; 95% C, 23.26-30.29) than those who experienced type 1 events first (MI, 15.33 per 100 patient-years; 95% CI, 13.73-17.12; CV mortality, 11.04 per 100 patient-years; 95% CI, 9.77-12.46; all-cause mortality, 14.98 per 100 patient-years; 95% CI, 13.5-16.63).
“The overall take-home message for physicians is that a type 2 MI event should not be overlooked, because these are high-risk patients and once the acute concomitant condition is addressed, these patients still need optimization of their cardiovascular treatment,” Chiara Melloni, MD, MHS, FACC, associate professor of medicine and member of the Duke Clinical Research Institute at Duke University School of Medicine, told Healio. “Research is needed to better characterize these patients and to identify treatments to reduce the risk of death and recurrent events following type 2 MI.
“We found that in the year after a MI event, patients who suffer a type 2 MI have an increased risk of death and recurrent cardiovascular events when compared with patients who had suffered a type 1 MI, and this can mostly be explained by the fact that they have a high prevalence of comorbidities and they are overall sicker patients,” Melloni said in an interview. “Also, since the type 2 MI occurs in the contest of another critical condition such as severe arrhythmias or severe hypotension/shock or severe anemia, physicians primarily treat these conditions first and the management of type 2 MI remains uncertain. The most surprising finding was that the observed increased all-cause mortality in type 2 MI patients remained consistent across troponin peak strata, and patients with type 2 MI who had a small elevation in troponin still had higher risk of overall mortality compared with type 1 MI patients who had a more prominent release of troponin.”
Using three large randomized clinical trials, researchers aimed to assess the incidence of type 1 and type 2 MI; described the characteristics of patients with type 2 MI vs. type 1 MI; evaluated clinical outcomes by MI type; and assessed the association between peak troponin levels, MI type and clinical outcomes. – by Scott Buzby
Melloni C, et al. Presentation 139. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosure: Melloni reports no relevant financial disclosures.