title: Type-II myocardial infarction--patient characteristics, management and outcomes.
abstract: BACKGROUND
  Type-II MI is defined as myocardial infarction (MI) secondary to ischemia due to either increased oxygen demand or decreased supply. This categorization has been used for the last five years, yet, little is known about patient characteristics and clinical outcomes. In the current work we assessed the epidemiology, causes, management and outcomes of type II MI patients.
  
  
  METHODS
  A comparative analysis was performed between patients with type-I and type-II MI who participated in two prospective national Acute Coronary Syndrome Israeli Surveys (ACSIS) performed in 2008 and 2010.
  
  
  RESULTS
  The surveys included 2818 patients with acute MI of whom 127 (4.5%) had type-II MI. The main causes of type-II MI were anemia (31%), sepsis (24%), and arrhythmia (17%). Patients with type-II MI tended to be older (75.6±12 vs. 63.8±13, p<0.0001), female majority (43.3% vs. 22.3%, p<0.0001), had more frequently impaired functional level (45.7% vs. 17%, p<0.0001) and a higher GRACE risk score (150±32 vs. 110±35, p<0.0001). Patients with type-II MI were significantly less often referred for coronary interventions (36% vs. 89%, p<0.0001) and less frequently prescribed guideline-directed medical therapy. Mortality rates were substantially higher among patients with type-II MI both at thirty-day (13.6% vs. 4.9%, p<0.0001) and at one-year (23.9% vs. 8.6%, p<0.0001) follow-ups.
  
  
  CONCLUSIONS
  Patients with type-II compared to type-I MI have distinct demographics, increased prevalence of multiple comorbidities, a high-risk cardiovascular profile and an overall worse outcome. The complex medical condition of this cohort imposes a great therapeutic challenge and specific guidelines with recommended medical treatment and invasive strategies are warranted.
authors.affiliation: Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Gideon Y
authors.initials: GY
authors.lastname: Stein
authors.affiliation: Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Herscovici
authors.affiliation: Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Roman
authors.initials: R
authors.lastname: Korenfeld
authors.affiliation: Cardiology Institute, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.affiliation: Neufeld Heart Research Institute, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel ; Cardioogy Department, Bikur Cholim Hospital, Jerusalem, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.affiliation: Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Danny
authors.initials: D
authors.lastname: Alon
authors.affiliation: Cardiology Institute, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Natalie
authors.initials: N
authors.lastname: Gevrielov-Yusim
authors.affiliation: Cardiology Department, Beilinson Hospital, Rabin Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Iakobishvili
authors.affiliation: Internal Medicine "B", Beilinson Hospital, Rabin Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Fuchs
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome