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Background

Type-II MI is defined as myocardial infarction MI secondary to ischemia due to either increased oxygen demand or decreased supply. This categorization has been used for the last five years, yet, little is known about patient characteristics and clinical outcomes. In the current work we assessed the epidemiology, causes, management and outcomes of type II MI patients.

Methods

A comparative analysis was performed between patients with type-I and type-II MI who participated in two prospective national Acute Coronary Syndrome Israeli Surveys ACSIS performed in 2008 and 2010.

Results

The surveys included 2818 patients with acute MI of whom 127 4.5% had type-II MI. The main causes of type-II MI were anemia 31%, sepsis 24%, and arrhythmia 17%. Patients with type-II MI tended to be older 75.6±12 vs. 63.8±13, p<0.0001, female majority 43.3% vs. 22.3%, p<0.0001, had more frequently impaired functional level 45.7% vs. 17%, p<0.0001 and a higher GRACE risk score 150±32 vs. 110±35, p<0.0001. Patients with type-II MI were significantly less often referred for coronary interventions 36% vs. 89%, p<0.0001 and less frequently prescribed guideline-directed medical therapy. Mortality rates were substantially higher among patients with type-II MI both at thirty-day 13.6% vs. 4.9%, p<0.0001 and at one-year 23.9% vs. 8.6%, p<0.0001 follow-ups.

Conclusions

Patients with type-II compared to type-I MI have distinct demographics, increased prevalence of multiple comorbidities, a high-risk cardiovascular profile and an overall worse outcome. The complex medical condition of this cohort imposes a great therapeutic challenge and specific guidelines with recommended medical treatment and invasive strategies are warranted.



Autor: Gideon Y. Stein, Gabriel Herscovici, Roman Korenfeld, Shlomi Matetzky, Shmuel Gottlieb, Danny Alon, Natalie Gevrielov-Yusim, Zaza

Fuente: http://plos.srce.hr/



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