| 1. |
- Eggers, Kai M., 1962-, et al.
(författare)
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Management and outcome trends in type 2 myocardial infarction : an investigation from the SWEDEHEART registry
- 2023
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Despite poor prognosis, patients with type 2 myocardial infarction (MI) tend to be underdiagnosed and undertreated compared to those with type 1 MI. Whether this discrepancy has improved over time is uncertain. We conducted a registry-based cohort study investigating type 2 MI patients managed at Swedish coronary care units (n = 14,833) during 2010–2022. Multivariable-adjusted changes (first three vs last three calendar years of the observation period) were assessed regarding diagnostic examinations (echocardiography, coronary assessment), provision of cardioprotective medications (betablockers, renin–angiotensin–aldosterone-system inhibitors, statins) and 1-year all-cause mortality. Compared to type 1 MI patients (n = 184,329), those with type 2 MI less often had diagnostic examinations and cardioprotective medications. Increases in the use of echocardiography (OR 1.08 [95% confidence interval 1.06–1.09]) and coronary assessment (OR 1.06 [95% confidence interval 1.04–1.08]) were smaller compared to type 1 MI (pinteraction < 0.001). The provision of medications did not increase in type 2 MI. All-cause mortality rate in type 2 MI was 25.4% without temporal change (OR 1.03 [95% confidence interval 0.98–1.07]). Taken together, the provision of medications and all-cause mortality did ot improve in type 2 MI despite modest increases in diagnostic procedures. This emphasizes the need of defining optimal care pathways in these patients.
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| 2. |
- Gard, Anton, 1985-, et al.
(författare)
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Effect on long term mortality of clinical myocardial infarction diagnosis in non-type 1 myocardial infarction
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- ObjectiveType 2 myocardial infarction (MI) and myocardial injury are common conditions among patients with elevated cardiac troponins, both giving rise to therapeutic uncertainty among physicians since the effects of treating any of these conditions as MI are unknown. Therefore, the objective of this study was to compare treatment and prognosis in type 2 MI and myocardial injury, with and without a clinical MI diagnosis.DesignThis observational study included two cohorts; one with 964 consecutive patients with a clinical MI diagnosis and one with 281 consecutive patients without a clinical MI diagnosis in 2011. All were followed regarding all-cause death until February 2017 and all cases were retrospectively adjudicated into MI types or myocardial injury. Adjudicated type 2 MI and myocardial injury patients with a clinical MI diagnosis were compared to those without a clinical MI diagnosis.ResultsDiagnosis adjudication identified 138 and 37 type 2 MI and 86 and 185 myocardial injury with and without a clinical MI diagnosis respectively. In adjudicated type 2 MI, a clinical MI diagnosis was associated with more coronary angiography investigations (39.1% vs 5.4%, p <0.001) and an increased use of Aspirin, P2Y12 inhibitors, RAAS-blockers, beta blockers and statins (all with p <0.001). However, no difference was observed in adjusted five year all-cause mortality between patients with and without a clinical MI diagnosis (hazard ratio: 0.71 with 95% confidence interval 0.39-1.30). The results were similar for adjudicated myocardial injury.ConclusionIn both type 2 MI and myocardial injury, a clinical MI diagnosis was associated with more investigations and treatment targeting coronary artery disease. However, no prognostic effect of receiving a clinical MI diagnosis could be observed for either of these conditions.
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| 3. |
- Gard, Anton, 1985-, et al.
(författare)
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Impact of clinical diagnosis of myocardial infarction in patients with elevated cardiac troponin
- 2023
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Ingår i: Heart. - : BMJ Publishing Group Ltd. - 1355-6037 .- 1468-201X. ; 109:20, s. 1533-1541
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Tidskriftsartikel (refereegranskat)abstract
- Objective Type 2 myocardial infarction (MI) and myocardial injury are common conditions associated with an adverse prognosis. Physicians experience uncertainty how to distinguish these conditions, as well as how to manage and treat them. Therefore, the objective of this study was to compare treatment and prognosis in patients with an adjudicated diagnosis of type 2 MI and myocardial injury, who were discharged with and without a clinical diagnosis of MI.Design The study consisted of two cohorts, 964 and 281 consecutive patients with elevated cardiac troponin, discharged with and without a clinical diagnosis of MI, respectively. All cases were adjudicated into MI type 1–5 or myocardial injury and followed regarding all-cause death.Results The adjudication identified 138 and 37 cases of type 2 MI, and 86 and 185 of myocardial injury, with and without a clinical MI diagnosis, respectively. In patients with type 2 MI, a clinical MI diagnosis was associated with more coronary angiography investigations (39.1% vs 5.4%, p<0.001) and an increased use of secondary prevention medications (all p<0.001). However, no difference was observed in adjusted 5-year mortality between patients with and without a clinical MI diagnosis (HR: 0.77 with 95% CI 0.43 to 1.38). The results were similar for adjudicated myocardial injury.Conclusion In both type 2 MI and myocardial injury, a clinical diagnosis of MI at discharge was associated with more investigations and treatments. However, no prognostic effect of receiving a clinical MI diagnosis was observed.
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| 4. |
- Gard, Anton, 1985-, et al.
(författare)
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Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments.
- 2020
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Ingår i: Journal of Clinical Medicine. - BASEL SWITZERLAND : MDPI AG. - 2077-0383. ; 10:1
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD.METHODS: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018.RESULTS: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62-3.22), one year (HR 1.82; 95% CI 1.39-2.36) and five years (HR 1.62; 95% CI 1.32-1.98).CONCLUSIONS: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.
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| 5. |
- Gard, Anton, 1985-
(författare)
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Type 2 myocardial infarction : Aspects of diagnosis, prognosis and treatment
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unlike the coronary thromboembolic type 1 myocardial infarction (MI), a type 2 MI occurs secondary to other conditions causing an imbalance in myocardial oxygen supply and demand. Type 2 MI is associated with high mortality and evidence based treatment is lacking. It may also be difficult to differentiate type 2 MI from type 1 MI and myocardial injury, which causes uncertainty among physicians. Therefore, the aim of this thesis was to evaluate the current classification of MI types and myocardial injury with special emphasis on evaluating the therapeutic and prognostic importance of distinguishing and diagnosing type 2 MI. The validity of type 2 MI reports in the Swedish national register for MI (SWEDEHEART) was also investigated.The study populations consisted of 1328 patients with a clinical MI diagnosis from eight sites, whereof 792 had been reported to SWEDEHEART, as well as 281 patients with elevated cardiac troponins but without a clinical MI diagnosis from one site. The diagnosis of each patient was retrospectively adjudicated in accordance with the Third Universal Definition of Myocardial Infarction.Overall, the adjudicators agreed moderately when deciding the diagnosis and it was particularly difficult to distinguish type 2 MI and non-ischemic myocardial injury. Patients with type 2 MI were often treated outside cardiology departments which led to a significant underreporting to SWEDEHEART. Using the adjudicated diagnosis as a gold standard, type 2 MI registry reports had a positive predictive value of 62.5%. Receiving care outside cardiology departments was found to be associated with a lesser use of MI specific therapies and an adverse short and long term prognosis in MI patients overall. However, although clinically unrecognized type 2 MI patients received the least cardiology care in all aspects, this was still not observed to significantly affect the long term prognosis.In conclusion; the current MI classification defines type 2 MI as a very heterogeneous condition that is difficult to distinguish. This makes clinically defined type 2 MI populations, such as the one in SWEDEHEART, unreliable and it also makes it difficult to find and apply specific, prognostically relevant recommendations and therapeutic strategies for this serious condition.
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| 6. |
- Taggart, Caelan, et al.
(författare)
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Application of the Universal Definition of Myocardial Infarction in Clinical Practice in Scotland and Sweden
- 2024
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Ingår i: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Whether the diagnostic classifications proposed by the universal definition of myocardial infarction (MI) to identify type 1 MI due to atherothrombosis and type 2 MI due to myocardial oxygen supply-demand imbalance have been applied consistently in clinical practice is unknown.Objective: To evaluate the application of the universal definition of MI in consecutive patients with possible MI across 2 health care systems.Design, Setting, and Participants: This cohort study used data from 2 prospective cohorts enrolling consecutive patients with possible MI in Scotland (2013-2016) and Sweden (2011-2014) to assess accuracy of clinical diagnosis of MI recorded in hospital records for patients with an adjudicated diagnosis of type 1 or type 2 MI. Data were analyzed from August 2022 to February 2023.Main Outcomes and Measures: The main outcome was the proportion of patients with a clinical diagnosis of MI recorded in the hospital records who had type 1 or type 2 MI, adjudicated by an independent panel according to the universal definition. Characteristics and risk of subsequent MI or cardiovascular death at 1 year were compared.Results: A total of 50 356 patients were assessed. The cohort from Scotland included 28 783 (15 562 men [54%]; mean [SD] age, 60 [17] years), and the cohort from Sweden included 21 573 (11 110 men [51%]; mean [SD] age, 56 [17] years) patients. In Scotland, a clinical diagnosis of MI was recorded in 2506 of 3187 patients with an adjudicated diagnosis of type 1 MI (79%) and 122 of 716 patients with an adjudicated diagnosis of type 2 MI (17%). Similar findings were observed in Sweden, with 970 of 1111 patients with adjudicated diagnosis of type 1 MI (87%) and 57 of 251 patients with adjudicated diagnosis of type 2 MI (23%) receiving a clinical diagnosis of MI. Patients with an adjudicated diagnosis of type 1 MI without a clinical diagnosis were more likely to be women (eg, 336 women [49%] vs 909 women [36%] in Scotland; P < .001) and older (mean [SD] age, 71 [14] v 67 [14] years in Scotland, P < .001) and, when adjusting for competing risk from noncardiovascular death, were at similar or increased risk of subsequent MI or cardiovascular death compared with patients with a clinical diagnosis of MI (eg, 29% vs 18% in Scotland; P < .001).Conclusions and Relevance: In this cohort study, the universal definition of MI was not consistently applied in clinical practice, with a minority of patients with type 2 MI identified, and type 1 MI underrecognized in women and older persons, suggesting uncertainty remains regarding the diagnostic criteria or value of the classification.
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