Type 1 MI confers higher in-hospital mortality rate vs. type 2 MI, takotsubo syndrome
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Key takeaways:
- Type 1 MI is associated with higher in-hospital mortality rates than type 2 MI or takotsubo syndrome.
- All-cause readmissions at 30 days were highest in those with type 2 MI.
Compared with patients with type 2 MI or takotsubo syndrome, those with type 1 MI had higher in-hospital mortality rates, researchers reported in the Journal of the American Heart Association.
“Takotsubo syndrome and MI share similar clinical, electrocardiographic and laboratory characteristics and can be difficult to distinguish from each other in the acute setting. However, they differ in causes, management and outcomes as well as some demographics,” Pegah Khaloo, MD, MPH, postdoctoral research fellow at the Corrigan Minehan Heart Center, Massachusetts General Hospital, and colleagues wrote. “Introduction of subtypes of MI in 2007 made this distinction even more difficult. Type 1 MI is defined as myocardial necrosis due to atherothrombosis, whereas type 2 MI is defined as oxygen supply/demand mismatch in the absence of acute atherothrombosis. Prior studies have suggested that patients with type 2 MI have unique characteristics that are distinctly different from patients with type 1 MI. Although there are data comparing takotsubo syndrome with MI, there are no published studies that compare takotsubo syndrome with both type 1 and type 2 MI. Moreover, the current literature on type 2 MI is primarily limited to small single-center studies, and data on the prognosis of type 2 MI compared with type 1 MI are limited to mortality and readmission rates.”
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Comparing MI types, takotsubo syndrome
Khaloo and colleagues analyzed patients from the National Inpatient Sample and the National Readmission Database who were admitted to a U.S. hospital with type 1 MI (n = 2,035,055), type 2 MI (n = 639,075) or takotsubo syndrome (n = 43,335) from October 2017 to December 2019.
Of the three groups, those with type 1 MI had the highest in-hospital rates of cardiac arrest (type 1 MI, 4.02%; type 2 MI, 2.8%; takotsubo syndrome, 2.7%), ventricular fibrillation (type 1 MI, 3.2%; type 2 MI, 0.8%; takotsubo syndrome, 1.8%) and ventricular tachycardia (type 1 MI, 7.2%; type 2 MI, 5.4%; takotsubo syndrome, 5.3%), according to the researchers.
The takotsubo syndrome group had lower risk for in-hospital mortality compared with the type 1 MI group (3.3% vs. 7.9%; adjusted OR = 0.3; P < .001) and the type 2 MI group (3.3% vs. 8.2%; aOR = 0.3; P < .001), the researchers wrote.
Compared with the type 2 MI group, the type 1 MI group had higher odds of in-hospital mortality (aOR = 1.2; P < .001) and 30-day readmissions for a cardiac cause (aOR = 1.7; P < .001).
All-cause readmissions at 30 days were lower in the takotsubo syndrome group compared with the type 1 MI group (8% vs. 11.6%; aOR = 0.7; P < .001) and the type 2 MI group (8% vs. 15.3%; aOR = 0.6; P < .001), and they were higher in the type 2 MI group compared with the type 1 MI group (aOR = 0.9; P < .001), Khaloo and colleagues found.
Major differences in outcomes
“These results underscore major differences in outcomes for patients with different subtypes of MI and the need for different approaches to management,” Khaloo and colleagues wrote. “Type 1 MI requires close monitoring and early interventions to reduce the risk of subsequent cardiovascular events and readmissions. Conversely, patients with type 2 MI may benefit from management strategies that address not only their cardiac condition but also suspected precipitants to minimize their high risk of all-cause readmission. Although there are well-established guidelines for the treatment of type 1 MI, further studies will be required to establish evidence-based treatment guidelines for type 2 MI and takotsubo syndrome.”
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