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Type 2 Myocardial Infarction and Long-Term Mortality Risk Factors: A Retrospective Cohort Study

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Abstract

Introduction

In-hospital risk factors for type 1 myocardial infarction (MI) have been extensively investigated, but risk factors for type 2 MI are still emerging. Moreover, type 2 MI remains an underdiagnosed and under-researched condition. Our aim was to assess survival rates after type 2 MI and to analyze the risk factors for patient prognosis after hospitalization.

Methods

We conducted a retrospective database analysis of patients with MI diagnosis who were treated in Vilnius University Hospital Santaros Klinikos. A total of 6495 patients with the diagnosis of MI were screened. The primary study endpoint was long-term all-cause mortality. The predictive value of laboratory tests was estimated including blood hemoglobin, D dimer, creatinine, brain natriuretic peptide (BNP), C-reactive protein (CRP), and troponin levels.

Results

Out of all the patients diagnosed with MI there were 129 cases of type 2 MI (1.98%). Death rate almost doubled from 19.4% at 6 months to 36.4% after 2 years of follow-up. Higher age and impaired kidney function were risk factors for death both during hospitalization and after 2 years of follow-up. Lower hemoglobin (116.6 vs. 98.9 g/L), higher creatinine (90 vs. 161.9 μmol/L), higher CRP (31.4 vs. 63.3 mg/l), BNP (707.9 vs. 2999.3 ng/L), and lower left ventricle ejection fraction were all predictors of worse survival after 2 years of follow-up. Preventive medication during hospitalization can decrease the mortality risk: angiotensin-converting enzyme inhibitor (ACEi) (HR 0.485, 95% CI 0.286–0.820) and statins (HR 0.549, 95% CI 0.335–0.900). No significant influence was found for beta blockers (HR 0.662, 95% CI 0.371–1.181) or aspirin (HR 0.901, 95% CI 0.527–1.539).

Conclusions

There is significant underdiagnosis of type 2 MI (1.98% out of all MIs). If the patient is prescribed a preventive medication like ACEi or statins, the mortality risk is lower. Increased awareness of elevation of laboratory results could help to improve the treatment of these patients and identify the most vulnerable groups.

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Acknowledgements

We express our gratitude to Vilnius University Hospital Santaros Klinikos for allowing us to collect data.

Funding

This study has received funding from the European Social Fund (Lietuvos Mokslų Akademija) (project No 09.3.3-LMT-K- 712-0148) under a grant agreement with Research Council of Lithuania (LMTLT). The authors are funding the journal’s Rapid Service Fee.

Author Contributions

Data curation: Mindaugas Lizaitis, Egle Majauskienė, Petras Navickas, Rokas Šerpytis; Concept and design: Rokas Šerpytis., Sigita Glaveckaitė, Žaneta Petrulionienė, Qin M Chen, Joseph S Alpert, Pranas Šerpytis; Project administration: Rokas Šerpytis; Writing—original draft: Rokas Šerpytis, Mindaugas Lizaitis; Writing—review and editing: Rokas Šerpytis, Sigita Glaveckaitė, Žaneta Petrulionienė, Nomeda Valevičienė, Aleksandras Laucevičius, Qin M Chen, Joseph S Alpert, Pranas Šerpytis. All authors have read and agreed to the published version of the manuscript.

Disclosures

Rokas Šerpytis, Mindaugas Lizaitis, Egle Majauskienė, Petras Navickas, Sigita Glaveckaitė, Žaneta Petrulionienė, Nomeda Valevičienė, Aleksandras Laucevičius, Qin M Chen, Joseph S Alpert, and Pranas Šerpytis have nothing to disclose.

Compliance with Ethics Guidelines

The study was conducted in accordance with the Declaration of Helsinki and approved by the Local Ethics Committee of Vilnius University (consent Nr.158200- 18/4-1015-522, 2018-04-03). Patient consent was waived due to the retrospective nature of the study and the analysis used anonymous clinical data.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Clinic of Heart and Vessel Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Rokas Šerpytis, Mindaugas Lizaitis, Egle Majauskienė, Petras Navickas, Sigita Glaveckaitė, Žaneta Petrulionienė, Aleksandras Laucevičius & Pranas Šerpytis

  2. Faculty of Medicine, Vilnius University, Vilnius, Lithuania

    Nomeda Valevičienė

  3. Department of Medicine, University of Arizona Medical School, Tucson, USA

    Qin M. Chen & Joseph S. Alpert

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  1. Rokas Šerpytis
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Correspondence to Rokas Šerpytis.

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Šerpytis, R., Lizaitis, M., Majauskienė, E. et al. Type 2 Myocardial Infarction and Long-Term Mortality Risk Factors: A Retrospective Cohort Study. Adv Ther 40, 2471–2480 (2023). https://doi.org/10.1007/s12325-023-02485-2

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