Portal de Periódicos da CAPES

Effect of a Proposed Modification of the Type 1 and Type 2 Myocardial Infarction Definition on Incidence and Prognosis

2020; Lippincott Williams & Wilkins; Volume: 142; Issue: 21 Linguagem: Inglês

10.1161/circulationaha.120.048920

1524-4539

Hadrien Schoepfer, Thomas Nestelberger, Jasper Boeddinghaus, Raphael Twerenbold, Pedro López‐Ayala, Luca Koechlin, Desiree Wussler, Tobias Zimmermann, Òscar Miró, Francisco Javier Martín‐Sánchez, Michael Christ, Dagmar I. Keller, María Rubini Giménez, Christian Mueller, Danielle Menosi Gualandro, Ketina Arslani, Paul David Ratmann, Petra Hillinger, Mario Meier, Tania Coscia, Michael Freese, Joan Walter, Valentina Troester, Noemi Glarner, Christian Puelacher, Patrick Badertscher, Karin Wildi, Eliška Potluková, Damian Kawecki, Beata Morawiec, Franz Buergler, Nicolas Geigy, Tobias Reichlin,

Cardiovascular Function and Risk Factors

HomeCirculationVol. 142, No. 21Effect of a Proposed Modification of the Type 1 and Type 2 Myocardial Infarction Definition on Incidence and Prognosis Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toSupplementary MaterialsFree AccessLetterPDF/EPUBEffect of a Proposed Modification of the Type 1 and Type 2 Myocardial Infarction Definition on Incidence and Prognosis Hadrien Schoepfer, MD Thomas Nestelberger, MD Jasper Boeddinghaus, MD Raphael Twerenbold, MD Pedro Lopez-Ayala, MD Luca Koechlin, MD Desiree Wussler, MD Tobias Zimmermann, MD Oscar Miro, MD Javier F. Martín-Sánchez, MD Michael Christ, MD Dagmar I. Keller, MD Maria Rubini Gimenez, MD Christian MuellerMDFor the APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation) Investigators Danielle M. Gualandro, MD Ketina Arslani, MD Paul David Ratmann, MD Petra Hillinger, MD Mario Meier, MD Tania Coscia, MD Michael Freese, RN Joan Elias Walter, MD Valentina Troester, MD Noemi Glarner, PhDc Christian Puelacher, MD Patrick Badertscher, MD Karin Wildi, MD Eliska Potlukova, MD Damian Kawecki, MD Beata Morawiec, MD Franz Buergler, MD Nicolas Geigy, MD Tobias ReichlinMD Hadrien SchoepferHadrien Schoepfer Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Thomas NestelbergerThomas Nestelberger https://orcid.org/0000-0003-2173-5738 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). Division of Cardiology, Vancouver General Hospital, University of British Columbia, Canada (T.N.). , Jasper BoeddinghausJasper Boeddinghaus https://orcid.org/0000-0003-4404-4956 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Raphael TwerenboldRaphael Twerenbold https://orcid.org/0000-0003-3814-6542 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Pedro Lopez-AyalaPedro Lopez-Ayala https://orcid.org/0000-0002-7787-0640 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Luca KoechlinLuca Koechlin https://orcid.org/0000-0002-2929-8600 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. Department of Cardiac Surgery (L.K.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Desiree WusslerDesiree Wussler https://orcid.org/0000-0002-1793-5297 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. Division of Internal Medicine (D.W., T.Z.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Tobias ZimmermannTobias Zimmermann https://orcid.org/0000-0002-6862-5205 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. Division of Internal Medicine (D.W., T.Z.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). , Oscar MiroOscar Miro GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.). , Javier F. Martín-SánchezJavier F. Martín-Sánchez https://orcid.org/0000-0002-5970-725X GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain (J.F.M.-S.). , Michael ChristMichael Christ GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). Emergency Department Cantonal Hospital of Luzern, Switzerland (M.C.). , Dagmar I. KellerDagmar I. Keller Emergency Department, University Hospital Zurich, Switzerland (D.I.K.). , Maria Rubini GimenezMaria Rubini Gimenez https://orcid.org/0000-0003-2384-8250 Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. Department of Internal Medicine and Cardiology, Heart Center Leipzig-University Hospital, Germany (M.R.G.). , Christian MuellerChristian Mueller Christian Müller, MD, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Email E-mail Address: [email protected] Department of Cardiology and Cardiovascular Research Institute Basel (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., M.R.G., C.M.), University Hospital Basel, University of Basel, Switzerland. GREAT Network, Rome, Italy (H.S., T.N., J.B., R.T., P.L.-A., L.K., D.W., T.Z., O.M., J.F.M.-S., M.R.G., C.M.). and For the APACE (Advantageous Predictors of Acute Coronary Syndrome Evaluation) Investigators Originally published23 Nov 2020https://doi.org/10.1161/CIRCULATIONAHA.120.048920Circulation. 2020;142:2083–2085The 4th Universal Definition of Myocardial Infarction classifies myocardial infarction (MI) into 5 subtypes, of which types 1 and 2 MI are the most common.1,2 Type 1 MI (T1MI) is defined as MI caused by acute coronary atherothrombosis including plaque rupture and erosion. In contrast, type 2 MI (T2MI) is defined as MI resulting from myocardial oxygen supply/demand mismatch including central hemodynamic dearrangements such as tachyarrhythmia, hypotension, hypertension, anemia, and hypoxemia, as well as acute coronary pathologies that obstruct coronary blood flow such as spontaneous coronary artery dissection, coronary embolism, and coronary vasospasm.1,2 Because from pathophysiological, diagnostic, and management perspectives the latter are similar to T1MI and have little in common with other T2MI causes, modest revision of the Universal Definition of Myocardial Infarction has recently been proposed by a group of experts to reclassify spontaneous coronary artery dissection, coronary embolism, and coronary vasospasm from T2MI to T1MI.1–3 In addition, it was proposed to further subclassify T2MI into those patients with or without coronary artery disease.3 The impact of this proposed revision on the incidence and prognosis of T1MI and T2MI is largely unknown.Therefore, the aim of this study was to evaluate the impact of this proposed reclassification on the incidence and prognosis of T1MI and T2MI in a large, international, multicenter diagnostic study enrolling patients with acute chest discomfort using central adjudication by 2 independent cardiologists according to the Universal Definition of Myocardial Infarction in 5 European countries (URL: https://www.clinicaltrials.gov; Unique identifier: NCT00470587).4 The study has been approved by the local ethics committee, and written informed consent was obtained from all patients.Among 6145 patients, 1364 (22.2%) had MI, 1116 (81.8% of all MIs) had T1MI, and 248 (18.2% of all MIs) T2MI. The proposed revision resulted in 17 patients (6.8% of all T2MI) with spontaneous coronary artery dissection, coronary embolism, and coronary vasospasm being reclassified from T2MI to T1MInew (Figure). Among the remaining 231 patients with T2MInew, coronary artery disease was present in 104 (45% of all T2MInew) patients with T2AMI and absent in 127 (55% of all T2MInew) patients with T2BMI.Download figureDownload PowerPointFigure. Flowchart showing the placement of myocardial infarction patients following the proposed modification of the 4th Universal Definition of Myocardial Infarction. The percentages of "Count" are given for the total number of cases of redefined T1MI (T1MInew) and redefined T2MI (T2MInew), respectively. The percentages of all-cause death, new MI, and AHF are given for the respective subcategory. AHF indicates acute heart failure; CAD, coronary artery disease; MI, myocardial infarction; Microvasc. dysfunct, microvascular dysfunction; Rehosp. for AHF, rehospitalization for acute heart failure; SCAD, spontaneous coronary artery dissection; T1MI, type 1 myocardial infarction; and T2MI, type 2 myocardial infarction.Because of the relatively small number of reclassified patients, the overall number (1116 versus 1133), and 30-day (3.6% [40/1116] versus 3.5% [40/1133]) and 2-year all-cause mortality (12.0% [134/1116] versus 11.8% [134/1133]) were comparable between T1MI versus T1MInew. The same finding emerged for recurrent MI and hospitalization for acute heart failure (all P=NS, using the bootstrap resampling method with 1000 iterations).Two-year outcomes differed substantially among the categories of T2MInew. Two-year all-cause mortality was 25.0% (95% CI, 17.7%–34.1%, calculated with the Wilson score interval) in T2AMI versus 7.9% (95% CI, 4.3%–13.9%) in T2BMI (P 3 times higher than in T2BMI.Sources of FundingThe study was supported by research grants from the Swiss National Science Foundation, the Swiss Heart Foundation, the Kommission für Technologie und Innovation, the Stiftung für kardiovaskuläre Forschung Basel, Abbott, Beckman Coulter, Ortho Clinical Diagnostics, Quidel, Roche, Siemens, and Singulex.DisclosuresThe authors designed the study, gathered and analyzed the data, vouch for the data and analysis, wrote the letter, and decided to publish. Drs Hillinger, Nestelberger, Boeddinghaus, Twerenbold, Rubini, Koechlin, and Mueller had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the letter. The sponsors had no role in designing or conducting the study and no role in gathering or analyzing the data or writing the letter. The letter and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicly accessible websites or e-print servers. Dr Nestelberger has received research support from the Swiss National Science Foundation (P400PM_191037/1), the Prof. Dr. Max Cloëtta Foundation, the Margarete und Walter Lichtenstein-Stiftung (3MS1038), and the University Hospital Basel, as well as speaker honoraria/consulting honoraria from Beckman Coulter, Bayer, Ortho Clinical Diagnostics, and Orion Pharma, outside the submitted work. Dr Boeddinghaus received research grants from the University of Basel, the University Hospital of Basel and the Division of Internal Medicine, the Swiss Academy of Medical Sciences, and the Gottfried and Julia Bangerter-Rhyner-Foundation, and speaker honoraria/consulting honoraria from Siemens, Roche Diagnostics, Ortho Clinical Diagnostics, and Quidel Corporation, outside of the submitted work. Dr Badertscher has received research funding from the "Stiftung für Herzschrittmacher und Elektrophysiologie," outside the submitted work. Dr Wildi has received research funding from the Freiwillige Akademische Gesellschaft Basel and the Julia und Gottfried Bangerter-Rhyner Stiftung. Dr Rubini has received speaker honoraria from Abbott and research support from the Swiss Heart Foundation, outside the submitted work. Dr Twerenbold reports research support from the Swiss National Science Foundation (grant No. P300PB_167803), the Swiss Heart Foundation, the Swiss Society of Cardiology, the Cardiovascular Research Foundation Basel, the University of Basel, and the University Hospital Basel, and speaker honoraria/consulting honoraria from Abbott, Amgen, Astra Zeneca, Roche, Siemens, Singulex, and Thermo Scientific BRAHMS. Dr Arslani has received a research grant from the Swiss Academy of Medical Sciences and the Gottfried and Julia Bangerter-Rhyner-Foundation. Dr Mueller has received research support from the Swiss National Science Foundation, the Swiss Heart Foundation, the Kommission für Technologie und Innovation, the European Union, the University of Basel, the University Hospital Basel, the Stiftung für kardiovaskuläre Forschung Basel, Abbott, Beckman Coulter, Idorsia, Ortho Cinical Diagnostics, Quidel, Roche, Siemens, Singulex, and Sphingotec, as well as speaker honoraria/consulting honoraria from Acon, Amgen, Astra Zeneca, Boehringer Ingelheim, BMS, Idorsia, Novartis, Osler, Roche, and Sanofi, outside of the submitted work. The other authors report no conflicts.AppendixAPACE Trial InvestigatorsDanielle M. Gualandro, MD; Ketina Arslani, MD; Paul David Ratmann, MD; Petra Hillinger, MD; Mario Meier, MD; Tania Coscia, MD; Michael Freese, RN; Joan Elias Walter, MD; Valentina Troester, MD; Noemi Glarner, PhDc; Christian Puelacher, MD; Patrick Badertscher, MD; Karin Wildi, MD; Eliska Potlukova, MD; Damian Kawecki, MD; Beata Morawiec, MD; Franz Buergler, MD; Nicolas Geigy, MD; Tobias Reichlin, MDFootnotes*Drs Schoepfer and Nestelberger contributed equally.†A complete list of the investigators in the APACE Trial is provided in the Appendix.https://www.ahajournals.org/journal/circData sharing: Data, detailed methods, and statistics are available on request to the corresponding author.Christian Müller, MD, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Email christian.[email protected]chReferences1. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018).Circulation. 2018; 138:e618–e651. doi: 10.1161/CIR.0000000000000617LinkGoogle Scholar2. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, Bax JJ, Borger MA, Brotons C, Chew DPet al.2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2016; 37:267–315. doi:10.1093/eurheartj/ehv320CrossrefMedlineGoogle Scholar3. De Lemos JA, Newby LK, Mills NL.A proposal for modest revision of the definition of type 1 and type 2 myocardial infarction.Circulation. 2016; 37:267–315. doi:10.1161/CIRCULATIONAHA.119.042157Google Scholar4. Nestelberger T, Boeddinghaus J, Badertscher P, Twerenbold R, Wildi K, Breitenbücher D, Sabti Z, Puelacher C, Rubini Giménez M, Kozhuharov Net al.; APACE Investigators. Effect of definition on incidence and prognosis of type 2 myocardial infarction.J Am Coll Cardiol. 2017; 70:1558–1568. doi: 10.1016/j.jacc.2017.07.774CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails November 24, 2020Vol 142, Issue 21Article InformationMetrics Download: 1,350 © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.120.048920PMID: 33226874 Originally publishedNovember 23, 2020 Keywordsprognosistype 1 myocardial infarctiontype 2 myocardial infarctionmyocardial infarctionPDF download SubjectsMyocardial InfarctionChronic Ischemic Heart DiseaseHeart FailureMortality/Survival