BACKGROUND Uncertainties regarding the most appropriate definition and treatment of type 2 myocardial infarction (T2MI) due to supply-demand mismatch have contributed to inconsistent adoption in clinical practice. OBJECTIVES This study sought a better understanding of the effect of the definition of T2MI on its incidence, treatment, and event-related mortality, thereby addressing an important unmet clinical need. METHODS The final diagnosis was adjudicated in patients presenting with symptoms suggestive of myocardial infarction by 2 independent cardiologists by 2 methods: 1 method required the presence of coronary artery disease, a common interpretation of the 2007 universal definition (T2MI2007); and 1 method did not require coronary artery disease, the 2012 universal definition (T2MI2012). RESULTS Overall, 4,015 consecutive patients were adjudicated. The incidence of T2MI based on the T2MI2007 definition was 2.8% (n = 112). The application of the more liberal T2MI2012 definition resulted in an increase of T2MI incidence of 6% (n = 240), a relative increase of 114% (128 reclassified patients, defined as T2MI2012reclassified). Among T2MI2007, 6.3% of patients received coronary revascularization, 22% dual-antiplatelet therapy, and 71% high-dose statin therapy versus 0.8%, 1.6%, and 31% among T2MI2012reclassified patients, respectively (all p < 0.01). Cardiovascular mortality at 90 days was 0% among T2MI2012reclassified, which was similar to patients with noncardiac causes of chest discomfort (0.2%), and lower than T2MI2007 (3.6%) and type 1 myocardial infarction (T1MI) (4.8%) (T2MI2012reclassified vs. T2MI2007 and T1MI: p = 0.03 and 0.01, respectively). CONCLUSIONS T2MI2012reclassified has a substantially lower event-related mortality rate compared with T2MI2007 and T1MI. (Advantageous Predictors of Acute Coronary Syndromes Evaluation [APACE] Study; NCT00470587).

中文翻译：

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定义对2型心肌梗死发生率和预后的影响

背景 由于供需不匹配，关于 2 型心肌梗死 (T2MI) 的最合适定义和治疗的不确定性导致了临床实践中采用的不一致。目的 本研究旨在更好地了解 T2MI 的定义对其发病率、治疗和事件相关死亡率的影响，从而解决重要的未满足的临床需求。方法 由 2 位独立的心脏病专家通过 2 种方法对出现提示心肌梗塞症状的患者做出最终诊断：一种方法要求存在冠状动脉疾病，这是 2007 年通用定义 (T2MI2007) 的通用解释；和 1 方法不需要冠状动脉疾病，2012 年通用定义 (T2MI2012)。结果 总体而言，4，015 名连续患者被裁定。根据 T2MI2007 定义，T2MI 的发生率为 2.8%（n = 112）。应用更宽松的 T2MI2012 定义导致 T2MI 发生率增加 6%（n = 240），相对增加 114%（128 名重新分类的患者，定义为 T2MI2012 重新分类）。在 T2MI2007 中，6.3% 的患者接受了冠状动脉血运重建、22% 的双重抗血小板治疗和 71% 的高剂量他汀类药物治疗，而在 T2MI2012 重新分类的患者中，分别为 0.8%、1.6% 和 31%（所有 p < 0.01）。T2MI2012重新分类的90天心血管死亡率为0%，与胸部不适的非心脏原因患者（0.2%）相似，低于T2MI2007（3.6%）和1型心肌梗死（T1MI）（4.8%）（T2MI2012重新分类与. T2MI2007 和 T1MI：p = 0.03 和 0.01，分别）。结论与 T2MI2007 和 T1MI 相比，重新分类的 T2MI2012 具有显着较低的事件相关死亡率。（急性冠状动脉综合征评估 [APACE] 研究的有利预测因子；NCT00470587）。