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Variations on classification of main types of myocardial infarction: a systematic review and outcome meta-analysis
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2019 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 7, p. 749-762Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer, 2019. Vol. 108, no 7, p. 749-762
Keywords [en]
Acute coronary syndrome, Classification, Type 1 myocardial infarction, Type 2 myocardial infarction, Universal definition
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-374213DOI: 10.1007/s00392-018-1403-3ISI: 000472151100004PubMedID: 30535801OAI: oai:DiVA.org:uu-374213DiVA, id: diva2:1280391
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-08-07Bibliographically approved

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Lindahl, Bertil

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