Abstract 139: A Novel Taxonomy for Acute Myocardial Infarction in Young Women

Autor: Erica S Spatz, Leslie Curry, Cary P Gross, Frederick A Masoudi, Rachel Dryer, Hector Bueno, Julianna F Lampropulos, Sarwat I Chaudhry, Shengfan Zhou, Gail D'Onofrio, John A Spertus, Basmah Safdar, Alexandra J Lansky, Harlan M Krumholz
Rok vydání: 2014
Předmět:
Zdroj: Circulation: Cardiovascular Quality and Outcomes. 7
ISSN: 1941-7705
1941-7713
Popis: Background: In young women, the mechanism of injury in AMI is heterogeneous. Current classification schemes may not accommodate the breadth of phenotypic presentations in this population. Methods: We aimed to develop a new taxonomy for young women with AMI based on a random sample of patients enrolled in VIRGO, a multinational cohort study of young (≤55y) AMI patients. All met criteria for AMI with elevations of cardiac biomarkers and either chest pain or ECG changes. Five physicians abstracted data from the medical record using a structured instrument. Chart review focused on domains hypothesized to be relevant to clinical care and prognosis: clinical symptoms (e.g., chest pain, trigger, abruptness); clinical substrate for supply-demand mismatch (criteria defined in the abstraction instrument); underlying mechanism (assigned with probable/definite certainty); angiographic findings, (e.g., culprit artery); LV systolic function; and troponin elevation. We classified AMI phenotypes as Type I (plaque rupture/thrombus), Type II (supply-demand mismatch) or Type 4b (stent thrombosis), based on the 3 rd Universal Definition. Using a systematic, empirical approach we developed a taxonomy by: (1) investigating heterogeneity within the current classification system, and (2) grouping patients with similar clinical characteristics into distinct classes, iteratively evaluating face validity with cardiologists. Results: According to the 3 rd Universal Definition, patients (n=598, 69% female; mean age 47y) were classified as: Type 1: 504 (84%); Type 2: 39 (7%); Type 4b: 2 ( Discussion: Nearly 1 in 10 young AMI patients are not captured by the current classification system; most are women. Moreover, there is wide heterogeneity in clinical presentation and extent of CAD among Type II AMI. A novel taxonomy may improve the complete classification of young women with AMI.
Databáze: OpenAIRE
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