Cardiovascular Mortality After Type 1 and Type 2 Myocardial Infarction in Young Adults |
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Affiliation: | 1. Department of Medicine, Yale University School of Medicine, New Haven, Connecticut;2. Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts;3. Department of Cardiology, Columbia University Medical Center, New York, New York;4. Department of Medicine, Tufts Medical Center, Boston, Massachusetts;5. Department of Medicine, Mayo Clinic, Rochester, Minnesota;6. Department of Pathology and Lab Medicine, Brigham and Women’s Hospital, Boston, Massachusetts;7. Cardiovascular Division, Massachusetts General Hospital, Boston, Massachusetts |
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Abstract: | BackgroundType 2 myocardial infarction (MI) and myocardial injury are associated with increased short-term mortality. However, data regarding long-term mortality are lacking.ObjectivesThis study compared long-term mortality among young adults with type 1 MI, type 2 MI, or myocardial injury.MethodsAdults age 50 years or younger who presented with troponin >99th percentile or the International Classification of Diseases code for MI over a 17-year period were identified. All cases were adjudicated as type 1 MI, type 2 MI, or myocardial injury based on the Fourth Universal Definition of MI. Cox proportional hazards models were constructed for survival free from all-cause and cardiovascular death.ResultsThe cohort consisted of 3,829 patients (median age 44 years; 30% women); 55% had type 1 MI, 32% had type 2 MI, and 13% had myocardial injury. Over a median follow-up of 10.2 years, mortality was highest for myocardial injury (45.6%), followed by type 2 MI (34.2%) and type 1 MI (12%) (p < 0.001). In an adjusted model, type 2 MI was associated with higher all-cause (hazard ratio: 1.8; 95% confidence interval: 1.2 to 2.7; p = 0.004) and cardiovascular mortality (hazard ratio: 2.7; 95% confidence interval: 1.4 to 5.1; p = 0.003) compared with type 1 MI. Those with type 2 MI or myocardial injury were younger and had fewer cardiovascular risk factors but had more noncardiovascular comorbidities. They were significantly less likely to be prescribed cardiovascular medications at discharge.ConclusionsYoung patients who experience a type 2 MI have higher long-term all-cause and cardiovascular mortality than those who experience type 1 MI, with nearly one-half of patients with myocardial injury and more than one-third of patients with type 2 MI dying within 10 years. These findings emphasize the need to provide more aggressive secondary prevention for patients who experience type 2 MI and myocardial injury. |
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Keywords: | outcomes myocardial injury troponin type 2 myocardial infarction young adults CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" Charlson Comorbidity Index CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" confidence interval HR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" hazard ratio ICD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" International Classification of Diseases MI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" myocardial infarction UDMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" Universal Definition of Myocardial Infarction |
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