One-year mortality in type 2 MI: Patient characteristics from a large clinical series
Patel RD, Olet S, Kram JJF, et al. One-year mortality in type 2 MI: Patient characteristics from a large clinical series. Presented at: International Academy of Cardiology, 22nd World Congress on Heart Disease; July 14-16, 2017; Vancouver, BC, Canada.
Presented at: International Academy of Cardiology, 22nd World Congress on Heart Disease; July 14-16, 2017; Vancouver, BC, Canada.
Background: Type 2 MI is caused by an imbalance in oxygen supply/demand. Little is known about the patient characteristics associated with Type 2 MI.
Objective: This study aimed to define patient characteristics of Type 2 MI.
Methods: We retrospectively studied patients older than 18 years presented to our health care facilities between 9/2011-12/2015. All patients determined to have Type 2 MI (i.e., if the patient had an elevated troponin greater than or equal to 0.05 ng/mL or diagnosis of demand ischemia) were included. We excluded those with troponin greater than 20.0 ng/mL, ST-elevation MI diagnosis, cardiogenic shock, or non-ST-elevation MI with percutaneous coronary intervention, stent placement, or coronary artery bypass surgery. Hospice discharges were also excluded. Cox proportional hazards model, Chi-squared and Fishers exact tests were used for statistical analysis for one-year mortality. Hazard ratios (HR) and associated 95% confidence intervals (CI) were also computed.
Results: A total of 21,139 patients [mean age 71+/- 16 years, females 10,565(49.9%)] fulfilled the study cohort. Univariate analysis showed that one-year mortality (28.5%) was high and associated with older age and White race (P’s<0.0001). A history of diabetes (P=0.037), aortic aneurysm (P=0.0008), congestive heart failure, atrial fibrillation, anemia, chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD; P’s<0.0001) were also associated with one-year mortality. One-year death rate was lower in patients with known history of coronary artery disease (CAD; P’s<0.0001). Multivariate analysis showed that anemia (P=<0.0001; HR=1.29, CI[1.22- 1.38]), COPD (P=<0.0001; HR=1.26, CI[1.16-1.37]) ,CKD (P=<0.0001; HR=1.16, CI[1.08- 1.24]), and diabetes (P=0.012; HR=1.08 CI[1.02-1.15]) were significantly associated with oneyear mortality. Additionally, a five year increase in age increases the risk of one-year mortality (HR=1.15, CI[1.14-1.16]).
Conclusion: Patients with Type 2 MI have several common characteristics which increases their likelihood of one-year mortality and a history of CAD is somewhat protective.