Type II Myocardial Infarction: Predisposing Factors, Precipitating Elements, and Outcomes

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Myocardial infarction (MI) is part of acute coronary syndrome (ACS).
• MI is classified into five types, with Type II MI arising from coronary insufficiency unrelated to plaque rupture.
• Data on Type II MI, especially in South Asia, is limited despite poorer outcomes.

Purpose of the Study:

• To outline predisposing factors, precipitating elements, and outcomes of Type II MI.
• To address the limited data on Type II MI in the South Asian context.

Main Methods:

• Prospective study at a tertiary care hospital in Kochi, Kerala, over 12 months.
• Inclusion of 59 patients (age 10-99) with final MI diagnosis, excluding prior interventions or non-ischemic causes.
• Data collection included demographics, cardiac biomarkers (CK-MB, Hs-Trop I), comorbidities, precipitating factors, sepsis sources, and outcomes.

Main Results:

• The mean age was 69.66 years, with 64.4% males.
• Common comorbidities included diabetes mellitus (74.57%), hypertension (69.49%), and dyslipidemia (64.4%).
• Sepsis (55.93%), anemia (52.4%), and electrolyte imbalance (49.1%) were frequent precipitating factors. Mortality was 32.20%, primarily due to heart failure and arrhythmias.

Conclusions:

• Type II MI is associated with high mortality, predominantly from heart failure and arrhythmias.
• Diabetes mellitus and hypertension are significant risk factors for Type II MI.
• Sepsis, particularly from the lower respiratory tract, is the most common precipitating factor; managing these factors is key to treatment.