Clinical Characteristics, Hospital Management Practices and In-Hospital Outcomes of Patients Hospitalized with Type 1 and Type 2 Myocardial Infarction

Objectives: To examine differences in patient characteristics, hospital management practices, and in-hospital outcomes between patients with type 1 (T1MI) and type 2 (T2MI) acute myocardial infarction (AMI).
Background: Extremely limited population-based data are available describing differences in these endpoints between patients with T1MI and T2MI.
Methods: Observational study of 1,047 residents of the Worcester (MA) metropolitan area hospitalized with confirmed AMI at all 11 central Massachusetts medical centers during 2011.
Results: T1MI was present in 75.3% (n= 788) of patients hospitalized with AMI. In comparison to patients with T1MI, patients with T2MI were older, more likely to be female, and had more comorbidities. A greater proportion of patients with T2MI presented to the emergency department with a major hemorrhage (6.2% vs. 0.1%), were more likely to have developed renal failure during their acute hospitalization (48.3% vs. 20.2%), but were less likely to have developed heart failure. Patients with T2MI were less likely to have received all 4 effective cardiac medications (88.4% vs. 93.7%) and coronary revascularization procedures (6.3% vs. 53.1%) and had a longer average hospital stay (10.6 days vs 4.7 days) than patients with T1MI.
Conclusions: A considerable proportion of patients hospitalized with AMI are diagnosed with T2MI. These patients present with different characteristics, may have a differential risk of clinical complications, and are managed differently than patients with T1MI. It remains important to study the clinical profile, in-hospital management, and outcomes of patients with T2MI and to determine the best therapeutic strategies to improve their short-term outcomes.