6533b82ffe1ef96bd12957bb

RESEARCH PRODUCT

Epidemiological approach of type 2 myocardial infarction : Etiologies, characteristics, treatment and prognosis.

subject

description

Introduction: Type 2 Myocardial infarction (MI)has been recently defined as an imbalance between oxygen supply and demand, in the absence of atherothromthrombosis. This work aimed to describe the main etiolgies as well as epidemiological, clinical and prognostic characteristics.Method: Data from patients with type 2 MI were collected from the RICO cohort (Observatoire des Infarctus de Cote d'Or). In a complementary work, we analyzed the retrospective data of the emergency department of Dijon University Hospital.Results: Among 4,436 consecutive patients hospitalized for MI in Dijon emergency department over 3 years, 947 (21%) had type 2 MI (median age: 81 years). In the RICO cohort, 4,572 consecutive patients, including 862 (19%) type 2 MI were included over 5 years (median age: 77 years). Intra-hospital mortality after type 2 MI was 14% among ED patients and 11% for RICO patients. The most common chronic conditions predisposing to type 2 MDI were severe anemia and severe aortic stenosis. An acute infection, from the respiratory tract for rougly 2/3 of them, was found in 10% of all MI in the RICO database, and was by far the most common precipitating factor in the pathogenesis of type 2 MI. Concerning therapeutics, after adjustments on propensity scores, red blood cell transfusion was associated with a one-year mortality reduction for patients >80 years of age with a hemoglobin nadir ≤ 8 g/dL. In Post-infectious PI, percutaneous coronary intervention was not associated with a better prognosis than drug treatment alone (one-year mortality of 24% vs 19%, p = 0.5).Conclusion:Type 2 MI is an underdiagnosed condition, representing 20% of all MI, and is common in the elderly. It is associated with an over-risk of mortality compared with type 1 MI. Acute infections, particularly from the respiratory tract, are the most common triggering factor. Based on observational data, invasive procedures do not appear to be associated with improved prognosis.