After type 2 myocardial infarction (T2MI) and myocardial injury, cardiovascular death was often linked to heart failure, stroke and vascular disease, according to a study published July 19 in the Journal of the American College of Cardiology.

In a community cohort study, Claire E. Raphael, MBBS, PhD, et al., assessed the cause-specific mortality rate in 4,665 patients after T2MI and myocardial injury compared to type 1 myocardial infarction (T1MI). Each patient selected had a serum cardiac troponin T (cTnT) concentration above the 99th percentile upper reference limit (≥0.01 ng/mL) reported in hospitals or clinics in Olmsted County, MN, from Jan. 1, 2003, to Dec. 31, 2012.

The cohort excluded patients with a history of MI, and mortality causes were categorized as either cardiovascular or non-cardiovascular, with cardiovascular deaths including acute MI, heart failure, cardiac death, vascular death and stroke.

The researchers identified 1,022 T2MI patients, 1,345 T1MI patients, 2,282 myocardial injury patients, and only 16 patients with other MI. After T2MI and myocardial injury, cardiovascular death was most frequently caused by heart failure, stroke or vascular disease. Compared to T1MI, fatal acute MI rates were lower after T2MI and myocardial injury.

"There remains a need to establish targets for cardiovascular mortality risk reduction after both T2MI and myocardial injury," the authors conclude. "The lower risk of fatal MI in the current study together with the low risk of nonfatal MI after T2MI that we previously demonstrated suggest that routine secondary preventative therapy may be less impactful than in T1MI." They add that moving forward, "further work is needed, including studies using a high-sensitivity troponin assay."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Troponin T, Troponin, Myocardial Infarction, Heart Failure, Myocardium, Stroke, Risk Reduction Behavior

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