ACC/AHA/ESC/WHF Universal Definition of Myocardial Infarction Classification System and the Risk of Cardiovascular Death: Observations from the TRITON-TIMI 38 Trial
Background—The availability of more sensitive biomarkers of myonecrosis and a new classification system from the Universal Definition of Myocardial Infarction (MI) have led to evolution of the classification of MI. The prognostic implications of MI defined in the current era have not been well described.
Methods and Results—We investigated the association between new or recurrent MI by subtype according to the ACC/AHA/ESC/WHF Task Force for the Redefinition of MI Classification System and the risk of cardiovascular (CV) death among 13,608 patients with acute coronary syndrome (ACS) in TRITON-TIMI 38. The adjusted risk of CV death was evaluated by landmark analysis starting at the time of the MI through 180 days after the event. Patients who experienced an MI during follow up had a higher risk of CV death at 6 months compared to patients without an MI (6.5% vs 1.3% vs, p<0.001). This higher risk was present across all subtypes of MI including Type 4a (Peri-PCI, 3.2%, p<0.001) and Type 4b (stent thrombosis, 15.4%, p<0.001). After adjusting for important clinical covariates, the occurrence of any MI was associated with a 5 fold higher risk of death at 6 months (95% CI 3.8 - 7.1) with similarly increased risk across subtypes.
Conclusions—MI is associated with a significantly increased risk of CV death with a consistent relationship across all types as defined by the Universal Classification System. These findings underscore the clinical relevance of these events and the importance of therapies aimed at preventing MI.
Clinical Trial Registration Information—http://www.clinicaltrials.gov; NCT00097591
- Received May 2, 2011.
- Accepted December 2, 2011.
- Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited