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Variations on classification of main types of myocardial infarction: a systematic review and outcome meta-analysis

  • Kris G. Vargas
  • Paul M. Haller
  • Bernhard Jäger
  • Maximilian Tscharre
  • Ronald K. Binder
  • Christian Mueller
  • Bertil Lindahl
  • Kurt Huber
Original Paper

Abstract

Objective

Classifying myocardial infarction into type 1 (T1MI) or type 2 (T2MI) remains a challenge in clinical practice. We aimed to identify factors contributing to variation in the classifications of MI into type 1 or type 2. In addition, pooled analyses of long-term mortality and reinfarction outcomes were performed.

Methods

We searched Medline, Embase and Web of Science through January 2018 for observational studies or clinical trials classifying patients as either T1MI or T2MI. Studies with baseline characteristics allowing a comparison between both groups were included. Inverse variance random-effects models were used to pool risk ratios (RR).

Results

Overall, 93,194 patients from 20 included observational studies were classified as T1MI and 9291 as T2MI; corresponding to 87.9% and 8.8% of all patients diagnosed with MI. Inclusion of ST-elevation MI patients was inconsistent among studies. Coronary angiography was performed in 77.7% and 31.5% of all patients with T1MI and T2MI, respectively. From a subgroup of 11 studies, percutaneous coronary intervention was performed in 79.2% of all patients classified as T1MI (range 44.2–93.0%) and 40.2% of all T2MI patients (range 0–87.5%). A meta-analysis of 6 studies (44,366 in total) on 2-year mortality showed worse outcome among T2MI patients (RR: 1.52, CI 1.07–2.17, P = 0.02; I2 = 92%). Risk of reinfarction at 1.6 years was higher among T2MI patients (RR: 1.68, CI 1.22–2.31, P = 0.001; I2 = 9%).

Conclusions

Classification of T1MI and T2MI varies widely among studies. A standardized approach with clear definitions is needed to avoid misclassification and ensure appropriate patient management.

Keywords

Type 1 myocardial infarction Type 2 myocardial infarction Acute coronary syndrome Universal definition Classification 

Notes

Funding

This work was supported by an unrestricted grant from the Association for the Promotion of Research in Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) and by the Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria. The study funders had no role in the design or conduct of the study.

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest in relation to this work.

Supplementary material

392_2018_1403_MOESM1_ESM.docx (120 kb)
Supplementary material 1 (DOCX 119 KB)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.3rd Department of Medicine, Cardiology and Intensive Care MedicineWilhelminen HospitalViennaAustria
  2. 2.Ludwig Boltzmann Cluster for Cardiovascular ResearchViennaAustria
  3. 3.Department of Cardiology and Intensive CareKlinikum Wels-GrieskirchenWelsAustria
  4. 4.Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital BaselBaselSwitzerland
  5. 5.Department of Medical Sciences and Uppsala Clinical Research CenterUppsala UniversityUppsalaSweden
  6. 6.Sigmund Freud Private University, Medical SchoolViennaAustria

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