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The prognosis of type 2 myocardial infarction : a systematic review with metaanalysis
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Introdução: A estratificação do prognóstico a curto e longo prazo do enfarte agudo do miocárdio (EAM) Tipo 1 (T1) e Tipo 2 (T2) permanece incerta. Uma vez que os doentes com EAMT2 são por norma mais idosos e apresentam mais comorbilidades, os estudos que associam o EAMT2 a pior prognóstico com base em resultados não ajustados a estas diferenças podem corresponder a uma sobrestimativa. Métodos: Partindo de pesquisa nas plataformas MEDLINE, CENTRAL e OpenGrey (novembro 2020), realizou-se uma revisão sistemática e meta-análise de estudos incluindo doentes com EAMT1 e T2, com resultados ajustados de mortalidade, eventos adversos cardiovasculares major (MACE) e EAM recorrente a curto e longo prazo. O risco de viés foi avaliado com base na ferramenta Robins-E. Foi utilizado um modelo de efeitos aleatórios para a meta-análise; os resultados foram apresentados sob forma de risco relativo (RR), com intervalo de confiança (IC) de 95%. A heterogeneidade foi avaliada através da estatística I2. Resultados: Foram incluídos 19 estudos, reunindo um total de 56172 doentes EAMT1 e 6698 EAMT2. O EAMT2 foi associado a aumento significativo da mortalidade por todas as causas a curto (RR: 1,96; 95% IC 1,25-3,09; 6 estudos) e longo (RR: 1.46; 95% IC 1.27 – 1.47; 16 estudos) prazo, embora a menor incidência de MACE (RR: 0.71; 95% CI 0.56 – 0.90; 4 estudos) e novo EAM (RR: 0.46; 95% CI 0.29 – 0.73; 6 estudos). A maioria dos resultados de interesse foi classificada como tendo um risco de viés moderado. Conclusão: Considerando resultados ajustados, o EAMT2 foi associado a pior prognóstico a curto e longo prazo, registando maior mortalidade por todas as causas, possivelmente decorrente de maior morbimortalidade por causas não cardiovasculares.
Introduction: Type 1 (T1) and Type 2 (T2) Myocardial Infarction (MI) are two wellestablished pathophysiological entities, but differences in short- and long-term prognosis are still unclear. Considering T2MI patients tend to be older and to have more comorbidities, T2MI's worse outcomes can be a misleading conclusion when no data adjustment for patient’s characteristics is made. Methods: We performed a systematic review and meta-analysis of studies retrieved in November 2020 from MEDLINE, CENTRAL, and OpenGrey, enrolling T1 and T2MI patients and reporting on adjusted mortality, major adverse cardiovascular events (MACE), and recurrent MI outcomes. The risk of bias was assessed under Robins-E tool guidance. Data were pooled using random-effects meta-analyses and risk ratio (RR) with the 95% confidence interval (95%CI). Heterogeneity was evaluated using I2 statistics. Results: Nineteen observational studies were eligible, yielding a total of 56172 T1MI and 6698 T2MI patients. T2MI was associated to significant higher short- (RR: 1.96; 95% CI 1.25-3.09; 6 studies) and long-term (RR: 1.46; 95% CI 1.27 – 1.47; 16 studies) all-cause mortality, but to lower risk of long-term MACE (RR: 0.71; 95% CI 0.56 – 0.90; 4 studies) and recurrent MI (RR: 0.46; 95% CI 0.29 – 0.73; 6 studies). Most of the outcomes in the included studies had a moderate risk of bias. Conclusion: In our adjusted comparison, T2MI was associated with a worse short- and long-term prognosis, as well as higher all-cause mortality, probably linked to a greater burden of non-cardiovascular conditions.
Introduction: Type 1 (T1) and Type 2 (T2) Myocardial Infarction (MI) are two wellestablished pathophysiological entities, but differences in short- and long-term prognosis are still unclear. Considering T2MI patients tend to be older and to have more comorbidities, T2MI's worse outcomes can be a misleading conclusion when no data adjustment for patient’s characteristics is made. Methods: We performed a systematic review and meta-analysis of studies retrieved in November 2020 from MEDLINE, CENTRAL, and OpenGrey, enrolling T1 and T2MI patients and reporting on adjusted mortality, major adverse cardiovascular events (MACE), and recurrent MI outcomes. The risk of bias was assessed under Robins-E tool guidance. Data were pooled using random-effects meta-analyses and risk ratio (RR) with the 95% confidence interval (95%CI). Heterogeneity was evaluated using I2 statistics. Results: Nineteen observational studies were eligible, yielding a total of 56172 T1MI and 6698 T2MI patients. T2MI was associated to significant higher short- (RR: 1.96; 95% CI 1.25-3.09; 6 studies) and long-term (RR: 1.46; 95% CI 1.27 – 1.47; 16 studies) all-cause mortality, but to lower risk of long-term MACE (RR: 0.71; 95% CI 0.56 – 0.90; 4 studies) and recurrent MI (RR: 0.46; 95% CI 0.29 – 0.73; 6 studies). Most of the outcomes in the included studies had a moderate risk of bias. Conclusion: In our adjusted comparison, T2MI was associated with a worse short- and long-term prognosis, as well as higher all-cause mortality, probably linked to a greater burden of non-cardiovascular conditions.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Enfarte agudo do miocárdio tipo 1 Enfarte agudo do miocárdio tipo 2 Definição universal de enfarte agudo do miocárdio Cardiologia