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10.1016/j.ijcard.2016.05.045

http://scihub22266oqcxt.onion/10.1016/j.ijcard.2016.05.045
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suck abstract from ncbi


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pmid27236114
      Int+J+Cardiol 2016 ; 218 (ä): 196-201
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  • Provoking conditions, management and outcomes of type 2 myocardial infarction and myocardial necrosis #MMPMID27236114
  • Smilowitz NR ; Weiss MC ; Mauricio R ; Mahajan AM ; Dugan KE ; Devanabanda A ; Pulgarin C ; Gianos E ; Shah B ; Sedlis SP ; Radford M ; Reynolds HR
  • Int J Cardiol 2016[Sep]; 218 (ä): 196-201 PMID27236114 show ga
  • BACKGROUND: Type 2 myocardial infarction (MI) is defined as myocardial necrosis (myonecrosis) due to an imbalance in supply and demand with clinical evidence of ischemia. Some clinical scenarios of supply-demand mismatch predispose to myonecrosis but limit the identification of symptoms and ECG changes referable to ischemia; therefore, the MI definition may not be met. Factors that predispose to type 2 MI and myonecrosis without definite MI, approaches to treatment, and outcomes remain poorly characterized. METHODS: Patients admitted to an academic medical center with an ICD-9 diagnosis of secondary myocardial ischemia or non-primary diagnosis of non-ST-elevation MI were retrospectively reviewed. Cases were classified as either MI (n=255) or myonecrosis without definite MI (n=220) based on reported symptoms, ischemic ECG changes, and new wall motion abnormalities. RESULTS: Conditions associated with type 2 MI or myonecrosis included non-cardiac surgery (38%), anemia or bleeding requiring transfusion (32%), sepsis (31%), tachyarrhythmia (23%), hypotension (22%), respiratory failure (23%), and severe hypertension (8%). Inpatient mortality was 5%, with no difference between patients with MI and those with myonecrosis (6% vs. 5%, p=0.41). At discharge, only 43% of patients received aspirin and statin therapy. CONCLUSIONS: Type 2 MI and myonecrosis occur frequently in the setting of supply-demand mismatch due to non-cardiac surgery, sepsis, or anemia. Myonecrosis without definite MI is associated with similar in-hospital mortality as type 2 MI; both groups warrant further workup for cardiovascular disease. Antiplatelet and statin prescriptions were infrequent at discharge, reflecting physician uncertainty about the role of secondary prevention in these patients.
  • |Aged [MESH]
  • |Aged, 80 and over [MESH]
  • |Aspirin/*therapeutic use [MESH]
  • |Electrocardiography [MESH]
  • |Female [MESH]
  • |Hospital Mortality [MESH]
  • |Humans [MESH]
  • |Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Myocardial Ischemia/*diagnosis/drug therapy/etiology [MESH]
  • |Myocardium/*pathology [MESH]
  • |Necrosis [MESH]
  • |Non-ST Elevated Myocardial Infarction/*diagnosis/drug therapy/etiology [MESH]
  • |Prognosis [MESH]
  • |Retrospective Studies [MESH]


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