Cardiovascular Risk Across Myocardial Injury and Infarction Categories Using the Universal Definition: An Individual...

Area of Science:

• Cardiology
• Clinical Research
• Epidemiology

Background:

• The Universal Definition classifies myocardial infarction (MI) by etiology, but its prognostic implications require further investigation.
• Understanding the long-term risks associated with different types of MI and myocardial injury is crucial for patient management.

Purpose of the Study:

• To compare the incidence and risk of recurrent MI or cardiovascular death in patients classified by the Universal Definition.
• To evaluate the prognostic significance of different etiologies of myocardial injury and infarction.

Main Methods:

• Systematic literature search of major databases (MEDLINE, EMBASE, Central, Web of Science) for prospective studies.
• Inclusion criteria: cardiac troponin measurement, Universal Definition adjudication, MI and mortality reporting for ≥1 year.
• Meta-analysis using random-effects models and subdistribution hazard ratios to account for competing risks.

Main Results:

• Analysis of 17 studies with 120,734 patients; Type 1 MI (9.4%), Type 2 MI (3.0%), acute myocardial injury (4.9%), chronic myocardial injury (4.7%).
• Increased risk of major adverse cardiovascular events (MACE) observed across all MI and injury types compared to controls.
• Type 2 MI showed a higher rate of noncardiovascular death, which influenced the overall MACE risk.

Conclusions:

• All patients with myocardial injury and infarction are at an elevated risk for future cardiovascular events.
• The prognostic impact of Type 2 MI is moderated by a significantly higher competing risk of noncardiovascular mortality.