Type 1 and 2 Myocardial Infarction and Myocardial Injury: Clinical Transition to High-Sensitivity Cardiac Troponin I

Yader Sandoval, Stephen W. Smith, Anne Sexter, Sarah E. Thordsen, Charles A. Bruen, Michelle D. Carlson, Kenneth W. Dodd, Brian E. Driver, Yan Hu, Katherine Jacoby, Benjamin K. Johnson, Sara A. Love, Johanna C. Moore, Karen Schulz, Nathaniel L. Scott, Fred S. Apple

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background Studies addressing patients with type 2 myocardial infarction and myocardial injury, including the impact of using high-sensitivity (hs) cardiac troponin (cTn) assays on their incidence are needed. Methods Ours is a prospective, observational US cohort study. Consecutive emergency department patients with serial cTnI measurements were studied. Outcomes included 180-day mortality and major adverse cardiac events, including 2-year follow-up for those with myonecrosis. Results Among 1640 patients, using a contemporary cTnI assay, 30% (n = 497) had ≥1 cTnI >99th percentile, with 4.7% (n = 77), 8.5% (n = 140), and 17% (n = 280) classified as type 1 myocardial infarction, type 2 myocardial infarction, and myocardial injury, respectively. Compared with patients without myonecrosis, 180-day mortality was higher for type 2 myocardial infarction (4% vs 13%, P <.0001) (adjusted hazard ratio 2.7; 95% confidence interval, 1.6-4.8; P =.0005) and myocardial injury (4% vs 11%, P <.0001) (adjusted hazard ratio 1.8; 95% confidence interval, 1.1-3.0; P =.02), both with mortality >20% at 2 years. Predictors of 2-year mortality for type 2 myocardial infarction included age, congestive heart failure, and beta-blockers. Relative to the contemporary cTnI assay, hs-cTnI had less myonecrosis (30% vs 26%, P =.003) and acute myocardial infarction (13.2% vs 10.8%, P =.032), including fewer type 2 myocardial infarctions (8.5% vs 6.3, P =.01), with no difference in myocardial injury (17% vs 15%, P =.1). Conclusions cTnI increases are encountered in approximately a third of patients, the majority due to nonatherothrombotic conditions. Compared with patients without myonecrosis, type 2 myocardial infarction and myocardial injury have worse short-term outcomes, with mortality rates >20% at 2 years. hs-cTnI assay does not lead to more myocardial injury or infarction.

Original languageEnglish (US)
Pages (from-to)1431-1439.e4
JournalAmerican Journal of Medicine
Volume130
Issue number12
DOIs
StatePublished - Dec 2017

Bibliographical note

Funding Information:
Funding: The UTROPIA study (NCT02060760) was partially funded through a grant from 1) Abbott Diagnostics, who had no role in the design and conduction of the study; including data collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the final manuscript; and b) the Minneapolis Medical Research Foundation.

Publisher Copyright:
© 2017 Elsevier Inc.

Keywords

  • Cardiac troponin
  • Myocardial infarction
  • Myocardial injury

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