Cardiovascular medications may improve outcomes for patients with type 2 myocardial infarction

1. Although infrequently prescribed, treatment with cardiovascular medications in patients with type 2 myocardial infarction (T2MI) and acute or chronic myocardial injury may lower mortality risk.

Evidence Rating Level:  2 (Good)

While patients with non-ischemic myocardial injury and type 2 myocardial infarction (T2MI) are associated with poorer outcomes and higher mortality, compared to patients with type 1 myocardial infarction (T1MI), there is ongoing debate regarding their treatment. Specifically, whether cardiovascular medications used in T1MI treatment would improve clinical outcomes in patients with other types of myocardial injury remains unknown. In this observational cohort study, records from 3 893 patients (mean age 73 years), taken from the Swedish National Patient Register, presenting with chest pain at the Karolinska University Hospital in Stockholm and with a discharge diagnosis of MI, were evaluated. Participants were divided into cohorts with T2MI, non-ischemic acute myocardial injury, and T1MI. They were then categorized according to the number of cardiovascular medications, calculated from all prescriptions dispensed within 180 days of their emergency department visit: those taking 0-1, 2-3, and 4 medications. Patients with T2MI and chronic myocardial injury were infrequently prescribed cardiovascular medications. For instance, approximately 15% of patients with T2MI and chronic myocardial injury did not receive any type of studied medicine (including ACEi, ARB, platelet inhibitors, and B-Blockers), such as only 40% of patients in these cohorts being given statins, compared to 87% of patients with T1MI.  With a mean follow-up of 3.1+ 1.5 years, 27% of patients died, with yearly mortality rates decreasing with increasing numbers of medications across all types of myocardial injury. For example, patients with T2MI treated with 2-3 and 4 medications were associated with 50% (aHR 0.50, NSD) and 56% (0.43, 95% CI 0.19-0.96) lower rates of mortality than those taking 0-1 medications. These findings support a more generous approach to prescribing cardiovascular medications in patients with T2MI and acute or chronic myocardial injury may reap mortality benefit. However, this study was limited by its observational methods, lack of additional patient history to eliminate residual confounders, and its small number of patients and events in certain analyses (i.e. only 8 deaths in the reference group). Future studies should clarify diagnoses by accessing coronary angiographies and stress tests, and explore the effect of prescribed doses of specific medications.

Click to read the study in JAHA

Image: PD

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