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2016 ; 218
(ä): 196-201
Nephropedia Template TP
gab.com Text
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English Wikipedia
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]