Abstract 227: Long Term Outcomes In Patients With Type 2 Myocardial Infarction With And Without Significant Change In Troponin Levels

Background: It is well known that morbidity and mortality are higher in patients with Type 2 Myocardial Infarction (T2MI) compared to Type 1 MI. Few studies have compared outcomes in T2MI patients with significant increase in troponins (Tpn) (Myocardial infarction [Inf]) vs Tpn elevation with no or an insignificant Tpn increase (Myocardial Injury [Inj]).

Method: Single center retrospective observational study evaluating patients admitted with an elevated Tpn-I and no evidence of obstructive coronary artery disease. Inj was defined as <50% increase if Tpn-I ≤ 1.0 ng/mL or <20% increase if Tpn-I > 1.0 ng/mL. Inf was defined as Tpn increase ≥ 50% if Tpn-I ≤ 1.0 ng/mL or ≥ 20% increase if Tpn-I > 1.0 ng/mL. Primary outcome was a composite of all-cause mortality, coronary revascularization, or admission for heart failure within 1 year.

Results: The study included 3,123 patients with a hospital admission between March 2019 to September 2019: 1609 patients with Inj and 1514 patients with Inf. Adjusted primary outcome was higher with Inf than Inj (p=0.02), as was revascularization (p=0.0017). Readmission for heart failure was not significantly different (p=0.26). Risk factors for primary outcomes (history of stroke, diabetes, ESRD, hypertension, and heart failure) were higher in the Inj group with lower primary outcomes. (Table)

Conclusion: Patients with T2MI (Inf pattern of Tpn) are more likely to have an adverse outcome within 1 year than patients with Inj. Clinical Implications: True T2MI (rise in Tpn) are more likely to have an adverse outcome and require catherization than patients with flat Tpn elevation who are more likely to have heart failure.