Sensitive Troponin Assay and the Classification of Myocardial Infarction

Shah, Anoop; McAllister, David A; Mills, Rosamund; Lee, Kuan Ken; Churchhouse, Antonia M.D.; Fleming, Kathryn; Layden, Elizabeth; Anand, Atul; Fersia, Omar; Joshi, Nikhil; Walker, Simon; Jaffe, Allan S.; Fox, Keith A.A.; Newby, David E.; Mills, Nicholas L.

doi:10.1016/j.amjmed.2014.10.056

Cited by 139 publications

(140 citation statements)

References 28 publications

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“…Shah et al [17] studied 1600 patients with MI, 429 of whom (27%) had type 2 MI. The use of PCI (0% vs. 49%; p < 0.001) and the administration of β blockers (36% vs. 63%, p < 0.001) were less frequent in patients with type 2 MI than in those with type 1 MI.…”

Section: Resultsmentioning

confidence: 99%

Cardiac troponins and mortality in type 1 and 2 myocardial infarction

Lippi

Sanchís-Gomar

Cervellin

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Background: The pathogenesis of different types of myocardial infarction (MI) differs widely, so that accurate and timely differential diagnosis is essential for tailoring treatments according to the underlying causal mechanisms. As the measurement of cardiac troponins is a mainstay for diagnosis and management of MI, we performed a systematic literature analysis of published works which concomitantly measured cardiac troponins in type 1 and 2 MI. Methods: The electronic search was conducted in Medline, Scopus and Web of Science using the keywords "myocardial infarction" AND "type(-)2" OR "type II" AND "troponin" in "Title/Abstract/Keywords", with no language restriction and date limited from 2007 to the present. Results: Overall, 103 documents were identified, but 95 were excluded as precise comparison of troponin values in patients with type 1 and 2 MI was unavailable. Therefore, eight studies were finally selected for our analysis. Two studies used high-sensitivity (HS) immunoassays for measuring cardiac troponin T (HS-TnT), one used a HS immunoassay for measuring cardiac troponin I (HS-TnI), whereas the remaining used conventional methods for measuring TnI. In all studies, regardless of type and assay sensitivity, troponin values were higher in type 1 than in type 2 MI. The weighted percentage difference between type 1 and 2 MI was 32% for TnT and 91% for TnI, respectively. Post-discharge mortality obtained from pooling individual data was instead three times higher in type 2 than in type 1 MI.

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Section: Resultsmentioning

confidence: 99%

Cardiac troponins and mortality in type 1 and 2 myocardial infarction

Lippi

Sanchís-Gomar

Cervellin

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…All observational studies through 30 June 2016 that compared presenting symptoms, baseline characteristics, interventions, and mortality outcomes between type 1 and type 2 MI were identified by conducting a search in the databases of PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE using the search terms "Type-1 myocardial infarction", "versus", "Type-2 myocardial infarction", and "Demand Ischemia" (5,8,9,(11)(12)(13)(14)(15)(16). We also searched the major cardiovascular conference proceedings, bibliographies of original trials, meta-analyses and review articles.…”

Section: Eligibility Criteria and Data Extractionmentioning

confidence: 99%

Type 2 versus type 1 myocardial infarction: a comparison of clinical characteristics and outcomes with a meta-analysis of observational studies

Gupta¹,

Vaidya²,

Arora³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: Type 2 myocardial infarction (MI) is an imbalance between myocardial oxygen demand and supply, leading to myocardial ischemia. It is not due to plaque rupture, and is usually caused by a condition other than coronary artery disease (CAD). However, limited data are available comparing the prevalence of traditional coronary risk factors and mortality between type 1 and type 2 MI. We hypothesize that type 2 MI carries a higher mortality than type 1. Methods:We searched the databases of PubMed, EMBASE, CENTRAL, and MEDLINE for studies comparing type 1 MI with type 2 MI. The baseline variables were compared in each cohort. Summary risk ratios and 95% confidence intervals were calculated using the random effects model to compare mortality between the two groups. Results:The included studies yielded 25,872 patients of whom 2,683 (10%) had type 2 MI. Compared to the type 1 cohort, the type 2 cohort had significantly higher inpatient (15% vs. 4.7%, P<0.00001), 30-day (17.6% vs. 5.3%, P<0.00001) and 1-yr mortality (27% vs. 13%, P<0.00001), as well as higher 30-day major adverse cardiovascular events (20% vs. 9%, P<0.0001). Operative stress (20%) was the most common trigger of type 2 MI, followed by sepsis (19%), arrhythmia (18.63%), heart failure (15%), and anemia (12%).Conclusions: Type 2 MI is a common entity and is more common in females, older age groups, and in patients with multiple comorbidities: it also tends to result in higher mortality.

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“…Moreover, the availability of high-sensitivity troponin assays will likely increase the number of patients who have elevated biomarkers in a variety of clinical conditions (9). Finally, the prognostic significance of type 2 MI is not well defined.…”

Section: Introductionmentioning

confidence: 99%