Abstract 4363492: Self-reported History of Heart Attack among Patients with Type 1 versus Type 2 Myocardial Infarction

Abstract

Background: The term “heart attack” is synonymous with myocardial infarction (MI). Epidemiologic studies that track MI incidence often rely on patient self-reported history of heart attack. We sought to compare patient self-reported history of heart attack shortly after a diagnosis of type 1 MI (T1MI) and type 2 MI (T2MI). Methods: In this single-center prospective cohort study, 150 consecutively eligible patients meeting strict Universal Definition of MI criteria for T1MI (n=75) and T2MI (n=75) were enrolled. Participants completed baseline (during their index MI hospitalization) and 1-month (4-6 weeks post-discharge) FRAIL scale questionnaires, including the question: “Did your doctor ever tell you that you have had a heart attack?” Multivariable logistic regression analysis evaluated the association between patient characteristics (age, sex, prior MI before the index MI, and presenting MI subtype) and self-reported history of heart attack. Results: 149 baseline questionnaires and 92 1-month questionnaires were available at the time of this analysis, in which 108 participants (72%) self-reported a diagnosis of heart attack at either baseline or 1 month. Among all participants (n=149), individuals who were White (79.6% vs 61.0%, p=0.006) and who had a prior MI before their index MI (24.1% vs 7.3%, p=0.04) more commonly self-reported a heart attack. Patients with T2MI less commonly reported having had a heart attack shortly after their MI as compared to T1MI (54.7% vs 90.5%, p<0.001). Among individuals with T2MI (n=75), individuals with a prior MI before their index MI (31.7% vs 8.8%, p=0.03), higher peak high-sensitivity troponin concentrations (363 ng/L [IQR, 132, 673] vs 139 ng/L [73, 363], p=0.02), and those who underwent invasive coronary angiography (63.4% vs 29.4%, p=0.007) more often self-reported a heart attack. After adjusting for age, gender, race, and prior MI, T2MI patients were significantly less likely to report a history of heart attack than T1MI patients (odds ratio: 0.13 [95% CI, 0.04, 0.32]). Conclusion: Individuals who experienced a T2MI were almost 8 times less likely to report having had a heart attack shortly after their MI event as compared to those with T1MI. These results suggest that epidemiology studies that rely on self-reported history of heart attack may not accurately capture all MI subtypes. Further research is needed to better understand how clinicians communicate a diagnosis of T2MI and patients’ understanding of the diagnosis.