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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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C5257344!5257344!27236114
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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 PMID27236114show 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.
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