Abstract 5338: Universal Definition of Myocardial Infarction Classification and the Risk of Cardiovascular Death: Observations From the TRITON-TIMI 38 Trial
The prognostic implications of new or recurrent MI after an acute coronary syndrome have not been completely defined in the era of the Universal Definition of Myocardial Infarction and newer more sensitive biomarker assays. Therefore, we investigated the association between new or recurrent MI by MI Type and the risk of cardiovascular death among 13,608 patients with ACS undergoing coronary intervention in the TRITON-TIMI 38 Trial.
METHODS: MI events were categorized on the basis of subtypes as defined by the AHA/ACC/ESC/WHF Task Force for the Redefinition of MI. The risk of CV death was evaluated by landmark analysis starting at the time of the new MI through the end of follow-up and adjusted for important clinical covariates. Outcomes were adjudicated by a blinded CEC.
RESULTS: Pts who experienced a MI during follow up were at higher risk of CV death at 6 months than patients who did not experience a MI (6.5% vs 1.3% vs, p<0.001). This association was present across all subtypes of MI with the highest rate among Type 4b (stent thrombosis, 15.4%) and the lowest among Type 4a (non-stent thrombosis PCI related) (figure⇓). After adjusting for important clinical covariates, the occurrence of any MI was associated with a 4 fold higher risk of death at 6 months (95% CI 3.3–5.6) with similar increased risk across subtype (figure⇓).
CONCLUSIONS: New or recurrent MI after ACS is associated with a significantly increased risk of CV death. This pattern is consistent across all types as defined by the Universal Classification System, including peri-procedural MI. These findings underscore the clinical relevance of these events and therapies aimed at attenuating this risk.