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dc.contributor.authorGuimaraes, Patricia O
dc.contributor.authorLeonardi, Sergio
dc.contributor.authorHuang, Zhen
dc.contributor.authorWallentin, Lars
dc.contributor.authorVan De Werf, Frans
dc.contributor.authorAylward, Philip Edmund
dc.contributor.authorHeld, Claes
dc.contributor.authorHarrington, Robert A
dc.contributor.authorMoliterno, David J
dc.contributor.authorArmstrong, Paul W
dc.contributor.authorWhite, Harvey D
dc.contributor.authorAlexander, Karen P
dc.contributor.authorLopes, Renato D
dc.contributor.authorMahaffey, Kenneth W
dc.contributor.authorTricoci, Pierluigi
dc.date.accessioned2017-11-23T03:29:45Z
dc.date.available2017-11-23T03:29:45Z
dc.date.issued2017-10-16
dc.identifier.citationGuimarães, P. O., Leonardi, S., Huang, Z., Wallentin, L., de Werf, F. V., Aylward, P. E., … Tricoci, P. (2018). Clinical features and outcomes of patients with type 2 myocardial infarction: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial. American Heart Journal, 196, 28–35. https://doi.org/10.1016/j.ahj.2017.10.007en
dc.identifier.issn0002-8703
dc.identifier.urihttp://hdl.handle.net/2328/37697
dc.descriptionThis manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Oct 2017) in accordance with the publisher’s archiving policyen_US
dc.description.abstractBackground: Type 2 myocardial infarction (MI) is characterized by an imbalance between myocardial blood supply and demand, leading to myocardial ischemia without coronary plaque rupture, but its diagnosis is challenging. Methods: In the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial, patients with non-ST-segment elevation acute coronary syndromes were included. We aimed to describe provoking factors, cardiac biomarker profiles, treatment patterns, and clinical outcomes of patients with type 2 MIs. MI events during trial follow-up were adjudicated by an independent clinical events classification committee (CEC) and were classified according to the Third Universal Definition of MI. Using available source documents retrieved as part of the CEC process, we performed a retrospective chart abstraction to collect details on the type 2 MIs. Cox regression models were used to explore the association between MI type (type 1 or type 2) and all-cause death. Results: Overall, 10.3% (n=1327) of TRACER participants had a total of 1579 adjudicated MIs during a median follow-up of 502 days (interquartile range [IQR] 349–667). Of all MIs, 5.2% (n=82) were CECadjudicated type 2 MIs, occurring in 76 patients. The incidence of type 2 MI was higher in the first month following randomization, after which the distribution became more scattered. The most frequent potential provoking factors for type 2 MIs were tachyarrhythmias (38.2%), anemia/bleeding (21.1%), hypotension/shock (14.5%), and hypertensive emergencies (11.8%). Overall, 36.3% had a troponin increase >10× the upper limit of normal. Coronary angiography was performed in 22.4% (n=17) of patients during hospitalizations due to type 2 MIs. The hazard of death was numerically higher following type 2 MI (vs. no MI, adj. HR 8.25, 95% CI 4.57–14.92; p<.0001) than that of type 1 MI (vs. no MI, adj. HR 5.71, 95% CI 4.62–7.06; p<.0001). Conclusions: Type 2 MIs were more prevalent in the first month after ACS were characterized by the presence of triggers and infrequent use of an invasive strategy, and were associated with a high risk of death. Further efforts are needed to better define the role and implications of type 2 MI in both clinical practice and research.en_US
dc.language.isoen
dc.publisherElsevieren
dc.rights© 2017 Elsevier Inc. All rights reserved.en
dc.subjectmyocardial infarctionen
dc.subjectacute coronary syndromesen
dc.subjectuniversal MI definitionen
dc.subjecttype 2 myocardial infarctionen
dc.titleClinical features and outcomes of patients with type 2 myocardial infarction: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trialen
dc.typeArticleen
dc.identifier.doihttps://doi.org/10.1016/j.ahj.2017.10.007en
dc.rights.holderElsevier Inc.en
dc.rights.licenseCC-BY-NC-ND


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