Clinical Features and Prognosis of Type 2 Myocardial Infarction in Vasospastic Angina.
Am J Med. 2014 Nov 26;
Authors: Matsue Y, Yoshida K, Hoshino M, Yonetsu T, Suzuki M, Matsumura A, Hashimoto Y, Yoshida M
BACKGROUND: Although prognosis of vasospastic angina is generally considered excellent, vasospasm has been shown to be a cause of type 2 myocardial infarction. This study was performed to investigate the clinical characteristics and prognosis of patients with vasospastic angina complicated with type 2 myocardial infarction .
METHODS: We performed a retrospective analysis of 171 consecutive patients with definite vasospastic angina (median age, 64 years; 55.0% male) who visited our hospital with chest pain and in whom cardiac troponin I (TnI) level was measured between 2005 and 2013. The patients were divided into type 2 myocardial infarction and non-type 2 myocardial infarction groups. A diagnosis of type 2 myocardial infarction was based on serum TnI value > 99th percentile upper reference limit. The primary endpoint was a combination of non-fatal myocardial infarction or death by any cause.
RESULTS: Forty-two (24.6%) patients were diagnosed as type 2 myocardial infarction , and the type 2 myocardial infarction group had a higher incidence of combined endpoint compared with the non-type 2 myocardial infarction group during the median follow-up of 4.4 years (26.2% vs. 9.3%, respectively, P = 0.008). Type 2 myocardial infarction remained an independent predictor of combined endpoint even after adjusting by the Japanese Coronary Spasm Association risk factors for combined endpoint (HR: 2.84; 95% CI: 1.22 - 6.61; P = 0.02).
CONCLUSION: Approximately one quarter of vasospastic angina patients were associated with type 2 myocardial infarction, and this population should be identified as a new high-risk subgroup of vasospastic angina patients requiring an alternative treatment strategy.
PMID: 25433303 [PubMed - as supplied by publisher]