Pranas Šerpytis, Sigita Glaveckaitė, Eglė Butkutė, Agnė Jucevičienė, Rokas Šerpytis
Abstract
Myocardial infarction is the leading cause of death in many countries around the world. The use of troponin in clinical practice as „gold standard” improved diagnostic of myocardial infarction without coronary artery occlusion. In 2007, the Task Force for the Universal Definition of Myocardial Infarction published an international consensus document, where 5 myocardial infarction subtypes were defined. Type II myocardial infarction brought confusion in clinical practice. There are the lack of data about differences between type I and II myocardial infarction frequency, symptoms and clinical outcomes. The aims of our study were to evaluate the clinical onset, course, treatment and outcome differences between patients with type I and II myocardial infarction. Study methods: Retrospective study was conducted to analyze data of 1583 patients with MI diagnosis registered in the database of Acute coronary syndromes monitoring system during the year 2011-2015 in Vilnius University clinics Santaros. Patients with type I and II myocardial infarction were analyzed. Demographic parameters, laboratory tests, interventional and medical treatment and disease outcomes were examined. Study results: Type I myocardial infarction was diagnosed for 1467 patients (87.95%), type II – 116 patients (6.95%). Comparing groups of patients with type II and I myocardial infarction significant differences were found between the number of patients with anemia, tachycardia, new onset atrial fibrillation and significantly (<100 m.) impaired functional capacity – all parameters were worse in patients with type II myocardial infarction. Group of patients with type II myocardial infarction also had lower troponin concentration, lower number of damaged coronary arteries and a lower degree of stenosis. Coronarography, percutaneous coronary intervention and antiplatelet treatment (54% vs. 76%; p<0.001) were applied less often for these patients. Group of patients with type II MI stood out with higher hospital mortality (10% vs. 4%; p=0.049). Conclusions: Type II MI is diagnosed almost 12 times less frequent than type I MI, however patients with type II MI have higher hospital mortality. Type II MI patients are more frequently diagnosed with anemia, tachycardia, new onset atrial fibrillation, significantly impaired functional capacity and lower troponin concentration than those with type I MI. Interventional and antiplatelet treatment is applied less often in type II MI patients.
Keyword(s): type 2 myocardial infarction; myocardial infarction; clasification of myocardial infarction.
DOI: 10.5200/sm-hs.2017.043
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