Now out in @JACCJournals we present interesting data from the largest, and first national, study of Type 2 MI in the United States!
@JJheart_doc @DhavalKolte @jasonwasfy @mvaduganathan @MGHHeartHealth

https://www.jacc.org/doi/10.1016/j.jacc.2020.12.034

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2/ Prior studies on type 2 MI, including work from our group, have predominantly been single healthcare system studies and therefore may be limited by instituitional practice patterns.

3/ As an ICD-10 code for type 2 MI was introduced in Oct 2017, an opportunity now exists to study this cohort in larger datasets such as the Nationwide Readmissions Database which captures all payor data from 28 U.S. states and 58% of all hospitalizations

4/ We examined patients coded with Type 2 MI in the first 3 months of the code in 2017. Notably, despite the infancy of code, type 2 MI cases made up 15% of MIs. Type 2 MI cases doubled from month 1 to 3 suggesting % of MI cases will be higher once coding practices stabilize

5/ We confirmed many findings from prior smaller studies: patients with type 2 MI are usually older, have a higher proportion of women, and more HF, AF, CKD than type 1 MI. Type 1 MI patients more likely to be smokers, have DM, HLD, and prior MI.

6/ We found that inhospital coronary angiography rates (11%), PCI (1.7%) and CABG (0.4%) rates are very low for type 2 MI in the Unites States. Patients who did undergo revasc were younger and more likely to be male.

7/ Notably, guidelines do not differentiate Type 1 from type 2 MI in their revascularization recs yet clinicians obviously are uncertain of the merits of PCI/CABG. RCT certainly needed to guide management.

8/ We found that although crude inhospital mortality rates were similar, after adjustment for comorbidities, type 2 MI patients actually had lower risk of mortality than type 1 MI. Type 2 MI patients had higher crude readmission rates but similar risk when adjusted.

9/ There are several other interesting findings and I would encourage you to read the paper if you have time. Drs. Thygesen and Jaffe provide an insightful editorial where they discuss the pros/cons of current ICD-10 coding system for MI.

https://www.jacc.org/doi/10.1016/j.jacc.2021.01.003