Amgad Mentias, Neil Keshvani, Milind Y Desai, Samir R Kapadia, Khaled M Ziada, Cian P McCarthy, Hurst M Hall, Ki Park, Dharam J Kumbhani, A Michael Lincoff, James L Januzzi, Ambarish Pandey
{"title":"医疗保险受益人中2型与1型心肌梗死的时间趋势、患者特征和结局。","authors":"Amgad Mentias, Neil Keshvani, Milind Y Desai, Samir R Kapadia, Khaled M Ziada, Cian P McCarthy, Hurst M Hall, Ki Park, Dharam J Kumbhani, A Michael Lincoff, James L Januzzi, Ambarish Pandey","doi":"10.1161/CIRCOUTCOMES.125.012136","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Type 2 myocardial infarction (MI) is common among older adults and is associated with adverse outcomes in single-center studies. We aimed to examine temporal trends and compare outcomes between type 1 and type 2 MI in Medicare beneficiaries.</p><p><strong>Methods: </strong>Medicare beneficiaries with type 1 or type 2 MI were identified using <i>International Classification of Diseases, Tenth Revision</i> codes from Medicare Provider Analysis and Review 100% inpatient files. Temporal trends were assessed from 2018 to 2021. Patients with type 2 MI were matched 1:1 to type 1 MI by age, sex, race, and year. Outcomes included all-cause mortality, recurrent MI, heart failure hospitalization (HFH), and stroke. Time-to-event analyses used Cox models for mortality and Fine-Gray models for hospitalization outcomes, with short-term (≤30 days) and long-term (>30 days) outcomes assessed using landmark analysis.</p><p><strong>Results: </strong>Among 1 816 926 Medicare beneficiaries, the proportion of type 2 MI increased from 19.4% in 2018 to 26.8% in 2021 (<i>P</i><sub>trend</sub><0.001). In propensity-matched analyses of 94 132 patients (mean age 77.3±11 years, 53.3% male), patients with type 2 (versus type 1) MI had lower short-term all-cause mortality (hazard ratio, 0.61 [95% CI, 0.59-0.63]), recurrent MI (subdistribution hazard ratio [sHR], 0.56 [95% CI, 0.54-0.59]), HFH (sHR, 0.56 [95% CI, 0.47-0.67]), and similar risk of stroke (sHR, 1.04 [95% CI, 0.90-1.21]). In long-term, patients with type 2 (versus type 1) MI had higher risk of all-cause mortality (hazard ratio, 1.23 [95% CI, 1.20-1.26]) and stroke (sHR, 1.20 [95% CI, 1.10-1.31]). The risk of recurrent MI and HFH associated with type 2 (versus type 1) MI in long-term follow-up was lower but considerably attenuated in magnitude compared with short-term risk (recurrent MI: sHR, 0.89 [95% CI, 0.86-0.94]; HFH; sHR, 0.73 [95% CI, 0.66-0.81]).</p><p><strong>Conclusions: </strong>Type 2 MI now accounts for over one-quarter of all MIs and is increasingly diagnosed. While patients with type 1 MI had higher short-term all-cause mortality risk, those with type 2 MI demonstrated higher long-term all-cause mortality and stroke risk, with lower risk of recurrent MI and HFH. These results highlight an urgent need for evidence-based strategies in this high-risk population.</p>","PeriodicalId":49221,"journal":{"name":"Circulation-Cardiovascular Quality and Outcomes","volume":" ","pages":"e012136"},"PeriodicalIF":6.7000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Temporal Trends, Patient Characteristics, and Outcomes of Type 2 Versus Type 1 Myocardial Infarction Among Medicare Beneficiaries.\",\"authors\":\"Amgad Mentias, Neil Keshvani, Milind Y Desai, Samir R Kapadia, Khaled M Ziada, Cian P McCarthy, Hurst M Hall, Ki Park, Dharam J Kumbhani, A Michael Lincoff, James L Januzzi, Ambarish Pandey\",\"doi\":\"10.1161/CIRCOUTCOMES.125.012136\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Type 2 myocardial infarction (MI) is common among older adults and is associated with adverse outcomes in single-center studies. We aimed to examine temporal trends and compare outcomes between type 1 and type 2 MI in Medicare beneficiaries.</p><p><strong>Methods: </strong>Medicare beneficiaries with type 1 or type 2 MI were identified using <i>International Classification of Diseases, Tenth Revision</i> codes from Medicare Provider Analysis and Review 100% inpatient files. Temporal trends were assessed from 2018 to 2021. Patients with type 2 MI were matched 1:1 to type 1 MI by age, sex, race, and year. Outcomes included all-cause mortality, recurrent MI, heart failure hospitalization (HFH), and stroke. Time-to-event analyses used Cox models for mortality and Fine-Gray models for hospitalization outcomes, with short-term (≤30 days) and long-term (>30 days) outcomes assessed using landmark analysis.</p><p><strong>Results: </strong>Among 1 816 926 Medicare beneficiaries, the proportion of type 2 MI increased from 19.4% in 2018 to 26.8% in 2021 (<i>P</i><sub>trend</sub><0.001). In propensity-matched analyses of 94 132 patients (mean age 77.3±11 years, 53.3% male), patients with type 2 (versus type 1) MI had lower short-term all-cause mortality (hazard ratio, 0.61 [95% CI, 0.59-0.63]), recurrent MI (subdistribution hazard ratio [sHR], 0.56 [95% CI, 0.54-0.59]), HFH (sHR, 0.56 [95% CI, 0.47-0.67]), and similar risk of stroke (sHR, 1.04 [95% CI, 0.90-1.21]). In long-term, patients with type 2 (versus type 1) MI had higher risk of all-cause mortality (hazard ratio, 1.23 [95% CI, 1.20-1.26]) and stroke (sHR, 1.20 [95% CI, 1.10-1.31]). The risk of recurrent MI and HFH associated with type 2 (versus type 1) MI in long-term follow-up was lower but considerably attenuated in magnitude compared with short-term risk (recurrent MI: sHR, 0.89 [95% CI, 0.86-0.94]; HFH; sHR, 0.73 [95% CI, 0.66-0.81]).</p><p><strong>Conclusions: </strong>Type 2 MI now accounts for over one-quarter of all MIs and is increasingly diagnosed. While patients with type 1 MI had higher short-term all-cause mortality risk, those with type 2 MI demonstrated higher long-term all-cause mortality and stroke risk, with lower risk of recurrent MI and HFH. These results highlight an urgent need for evidence-based strategies in this high-risk population.</p>\",\"PeriodicalId\":49221,\"journal\":{\"name\":\"Circulation-Cardiovascular Quality and Outcomes\",\"volume\":\" \",\"pages\":\"e012136\"},\"PeriodicalIF\":6.7000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation-Cardiovascular Quality and Outcomes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCOUTCOMES.125.012136\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/23 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation-Cardiovascular Quality and Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCOUTCOMES.125.012136","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Temporal Trends, Patient Characteristics, and Outcomes of Type 2 Versus Type 1 Myocardial Infarction Among Medicare Beneficiaries.
Background: Type 2 myocardial infarction (MI) is common among older adults and is associated with adverse outcomes in single-center studies. We aimed to examine temporal trends and compare outcomes between type 1 and type 2 MI in Medicare beneficiaries.
Methods: Medicare beneficiaries with type 1 or type 2 MI were identified using International Classification of Diseases, Tenth Revision codes from Medicare Provider Analysis and Review 100% inpatient files. Temporal trends were assessed from 2018 to 2021. Patients with type 2 MI were matched 1:1 to type 1 MI by age, sex, race, and year. Outcomes included all-cause mortality, recurrent MI, heart failure hospitalization (HFH), and stroke. Time-to-event analyses used Cox models for mortality and Fine-Gray models for hospitalization outcomes, with short-term (≤30 days) and long-term (>30 days) outcomes assessed using landmark analysis.
Results: Among 1 816 926 Medicare beneficiaries, the proportion of type 2 MI increased from 19.4% in 2018 to 26.8% in 2021 (Ptrend<0.001). In propensity-matched analyses of 94 132 patients (mean age 77.3±11 years, 53.3% male), patients with type 2 (versus type 1) MI had lower short-term all-cause mortality (hazard ratio, 0.61 [95% CI, 0.59-0.63]), recurrent MI (subdistribution hazard ratio [sHR], 0.56 [95% CI, 0.54-0.59]), HFH (sHR, 0.56 [95% CI, 0.47-0.67]), and similar risk of stroke (sHR, 1.04 [95% CI, 0.90-1.21]). In long-term, patients with type 2 (versus type 1) MI had higher risk of all-cause mortality (hazard ratio, 1.23 [95% CI, 1.20-1.26]) and stroke (sHR, 1.20 [95% CI, 1.10-1.31]). The risk of recurrent MI and HFH associated with type 2 (versus type 1) MI in long-term follow-up was lower but considerably attenuated in magnitude compared with short-term risk (recurrent MI: sHR, 0.89 [95% CI, 0.86-0.94]; HFH; sHR, 0.73 [95% CI, 0.66-0.81]).
Conclusions: Type 2 MI now accounts for over one-quarter of all MIs and is increasingly diagnosed. While patients with type 1 MI had higher short-term all-cause mortality risk, those with type 2 MI demonstrated higher long-term all-cause mortality and stroke risk, with lower risk of recurrent MI and HFH. These results highlight an urgent need for evidence-based strategies in this high-risk population.
期刊介绍：
Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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