Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Internal Medicine Neurology Oncology Pediatrics Respiratory Medicine Surgery
Congress Coverage
2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting

Keynote Webinar | Spotlight on Diet and Diabetes

Watch on-demand

An expert-led symposium exploring the prevention and management of type 2 diabetes through dietary interventions. 
ADVANCED SEARCH
Log in
Top
Clinical Research in Cardiology

Open Access 20-11-2023 | Myocardial Infarction | Original Paper

Long-term outcome of patients presenting with myocardial injury or myocardial infarction

Authors: Paul M. Haller, Caroline Kellner, Nils A. Sörensen, Jonas Lehmacher, Betül Toprak, Alina Schock, Tau S. Hartikainen, Raphael Twerenbold, Tanja Zeller, Dirk Westermann, Johannes T. Neumann

Published in: Clinical Research in Cardiology

Login to get access

Abstract

Aims

Patients with acute or chronic myocardial injury are frequently identified in the context of suspected myocardial infarction (MI). We aimed to investigate their long-term follow-up.

Methods and results

We prospectively enrolled 2714 patients with suspected MI and followed them for all-cause mortality and a composite cardiovascular endpoint (CVE; cardiovascular death, MI, unplanned revascularization) for a median of 5.1 years. Final diagnoses were adjudicated by two cardiologists according to the Fourth Universal Definition of MI, including 143 (5.3%) ST-elevation MI, 236 (8.7%) non-ST-elevation MI (NSTEMI) Type 1 (T1), 128 (4.7%) NSTEMI T2, 86 (3.2%) acute and 677 (24.9%) with chronic myocardial injury, and 1444 (53.2%) with other reasons for chest pain (reference). Crude event rates per 1000 patient-years for all-cause mortality were highest in patients with myocardial injury (81.6 [71.7, 92.3]), and any type of MI (55.9 [46.3, 66.7]), compared to reference (12.2 [9.8, 15.1]). Upon adjustment, all diagnoses were significantly associated with all-cause mortality. Moreover, patients with acute (adj-HR 1.92 [1.08, 3.43]) or chronic (adj-HR 1.59 [1.16, 2.18]) myocardial injury, and patients with NSTEMI T1 (adj-HR 2.62 [1.85, 3.69]) and ST-elevation MI (adj-HR 3.66 [2.41, 5.57]) were at increased risk for cardiovascular events.

Conclusion

Patients with myocardial injury are at a similar increased risk for death and cardiovascular events compared to patients with acute MI. Further studies need to determine appropriate management strategies for patients with myocardial injury.

Registration

Clinicaltrials.gov (NCT02355457).
Appendix
Available only for authorised users
Literature
1.
Niska R et al (2010) National hospital ambulatory medical care survey: 2007 emergency department summary. Natl Health Stat Report 26:1–31
2.
Hartikainen TS et al (2020) Clinical application of the 4th universal definition of myocardial infarction. Eur Heart J 41(23):2209–2216 CrossRefPubMed
3.
Westermann D et al (2017) High-sensitivity assays for troponin in patients with cardiac disease. Nat Rev Cardiol 14(8):472–483 CrossRefPubMed
4.
Collet JP et al (2021) 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 42(14):1289–1367 CrossRefPubMed
5.
Neumann JT et al (2016) Diagnosis of myocardial infarction using a high-sensitivity troponin I 1-hour algorithm. JAMA Cardiol 1(4):397–404 CrossRefPubMed
6.
Sorensen NA et al (2021) Diagnostic validation of a high-sensitivity cardiac troponin I assay. Clin Chem 9:1230–1239 CrossRef
7.
Thygesen K et al (2019) Fourth universal definition of myocardial infarction (2018). Eur Heart J 40(3):237–269 CrossRefPubMed
8.
Kadesjo E et al (2019) Acute versus chronic myocardial injury and long-term outcomes. Heart 105(24):1905–1912 CrossRefPubMed
9.
10.
Etaher A et al (2020) Type-II myocardial infarction and chronic myocardial injury rates, invasive management, and 4-year mortality among consecutive patients undergoing high-sensitivity troponin T testing in the emergency department. Eur Heart J Qual Care Clin Outcomes 6(1):41–48 PubMed
11.
Roos A et al (2018) Relation of chronic myocardial injury and non-ST-segment elevation myocardial infarction to mortality. Am J Cardiol 122(12):1989–1995 CrossRefPubMed
12.
Haller PM et al (2020) Performance of the ESC 0/1-h and 0/3-h algorithm for the rapid identification of myocardial infarction without ST-elevation in patients with diabetes. Diabetes Care 43(2):460–467 CrossRefPubMed
13.
Haller PM et al (2021) The association of anaemia and high-sensitivity cardiac troponin and its effect on diagnosing myocardial infarction. Eur Heart J Acute Cardiovasc Care 10(10):1187–1196 CrossRefPubMed
14.
Sörensen NA et al (2021) Differences in measurement of high-sensitivity troponin in an on-demand and batch-wise setting. Eur Heart J Acute Cardiovasc Care 10(3):302–309 CrossRef
15.
Roffi M et al (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European society of cardiology (ESC). Eur Heart J 37(3):267–315 CrossRefPubMed
16.
Schemper M et al (1996) A note on quantifying follow-up in studies of failure time. Control Clin Trials 17(4):343–346 CrossRefPubMed
17.
18.
Knuuti J et al (2020) 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 41(3):407–477 CrossRefPubMed
19.
Visseren FLJ et al (2021) 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 42(34):3227–3337 CrossRefPubMed
20.
21.
White HD et al (2014) Association of contemporary sensitive troponin I levels at baseline and change at 1 year with long-term coronary events following myocardial infarction or unstable angina: results from the LIPID study (long-term intervention with Pravastatin in ischaemic disease). J Am Coll Cardiol 63(4):345–354 CrossRefPubMed
22.
deFilippi CR et al (2016) Impact of moderate physical activity on the longitudinal trajectory of a cardiac specific biomarker of injury: results from a randomized pilot study of exercise intervention. Am Heart J 179:151–156 CrossRefPubMed
23.
Neumann JT et al (2017) Discrimination of patients with type 2 myocardial infarction. Eur Heart J 38(47):3514–3520 CrossRefPubMed
24.
Sandoval Y et al (2014) Cardiac troponin changes to distinguish type 1 and type 2 myocardial infarction and 180-day mortality risk. Eur Heart J Acute Cardiovasc Care 3(4):317–325 CrossRefPubMed
25.
Metadata
Title
Long-term outcome of patients presenting with myocardial injury or myocardial infarction
Authors
Paul M. Haller
Caroline Kellner
Nils A. Sörensen
Jonas Lehmacher
Betül Toprak
Alina Schock
Tau S. Hartikainen
Raphael Twerenbold
Tanja Zeller
Dirk Westermann
Johannes T. Neumann
Publication date
20-11-2023
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-023-02334-w
Webinar | 16-05-2023 | 17:30 (CET)

Keynote Webinar | Spotlight on Cardio-Oncology

Watch now

An expert-led symposium exploring the most pertinent issues in cardio-oncology, with a focus on the new ESC guidelines. Highlights include preventative approaches in cardio-oncology, toxicity risk-stratification strategies, the clinical management of myocarditis as an adverse effect of immune checkpoint inhibitor-treatments, and the utility of biomarkers in long-term follow-up of cardiovascular disease risk in cancer patients.
Prof. Rudolf de Boer
Prof. Lorenz Lehmann
Dr. Teresa Lopéz Fernández
Image Credits