Risk factors for type 1 and type 2 myocardial infarction

High-STEACS Investigators

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Whilst the risk factors for type 1 myocardial infarction due to atherosclerotic plaque rupture and thrombosis are established, our understanding of the factors that predispose to type 2 myocardial infarction during acute illness are still emerging. Our aim was to evaluate and compare the risk factors for type 1 and type 2 myocardial infarction. Methods and Results: We conducted a secondary analysis of a multi-centre randomised trial population of 48,282 consecutive patients attending hospital with suspected acute coronary syndrome. The diagnosis of myocardial infarction during the index presentation and all subsequent reattendances was adjudicated according to the Universal Definition of Myocardial Infarction. Cox regression was used to identify predictors of future type 1 and type 2 myocardial infarction during a one-year follow-up period. Within one-year, 1,331 patients had a subsequent myocardial infarction, with 924 and 407 adjudicated as type 1 and type 2 myocardial infarction, respectively. Risk factors for type 1 and type 2 myocardial infarction were similar, with age, hyperlipidaemia, diabetes, abnormal renal function, and known coronary disease predictors for both (P<0.05 for all). Whilst women accounted for a greater proportion of patients with type 2 as compared to type 1 myocardial infarction, after adjustment for other risk factors, sex was not a predictor of type 2 myocardial events (adjusted hazard ratio [aHR] 0.82, 95% confidence interval [CI] 0.66-1.01). The strongest predictor of type 2 myocardial infarction was a prior history of type 2 events (aHR 6.18, 95% CI 4.70-8.12). Conclusions: Risk factors for coronary disease that are associated with type 1 myocardial infarction are also important predictors of type 2 events during acute illness. Treatment of these risk factors may reduce future risk of both type 1 and type 2 myocardial infarction.
Original languageEnglish
JournalEuropean Heart Journal Open
Early online date25 Aug 2021
DOIs
Publication statusE-pub ahead of print - 25 Aug 2021

Keywords

  • Myocardial infarction
  • risk factors
  • universal definition
  • acute coronary syndrome
  • type 2

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