Utilization of Cardiovascular Procedures, Consultation Services, and Cardioprotective Medications Among Type 2 Myocardial Infarction Patients

Harsh Goel; Meera V Kapadia; Karan V Goenka; Caroline M Schaefer; Frances L Revere; James L Januzzi Jr; Saumil S Datar; Cian P McCarthy; Adwait G Mehta

doi:10.1016/j.jacadv.2025.101629

Utilization of Cardiovascular Procedures, Consultation Services, and Cardioprotective Medications Among Type 2 Myocardial Infarction Patients

JACC Adv. 2025 Mar;4(3):101629. doi: 10.1016/j.jacadv.2025.101629. Epub 2025 Feb 20.

Authors

Harsh Goel¹, Meera V Kapadia², Karan V Goenka², Caroline M Schaefer³, Frances L Revere⁴, James L Januzzi Jr⁵, Saumil S Datar², Cian P McCarthy⁶, Adwait G Mehta⁷

Affiliations

¹ Department of Cardiovascular Disease, The University of Texas Health Science Center, Houston McGovern Medical School, Houston, Texas, USA.
² Department of Internal Medicine, The University of Texas Health Science Center, Houston McGovern Medical School, Houston, Texas, USA.
³ Department of Management, Policy and Community Health, The University of Texas Health Science Center, Houston School of Public Health, Houston, Texas, USA.
⁴ University of Florida College of Public Health and Health Professionals, Gainesville, Florida, USA.
⁵ Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
⁶ Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁷ Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Electronic address: agmehta@mdanderson.org.

Abstract

Background: Coronary atherosclerosis and recurrent cardiovascular events are common among individuals with type 2 myocardial infarction (T2MI). However, cardiovascular resource utilization among T2MI patients is unclear.

Objectives: The aim of the study was to characterize cardiovascular resource utilization among T2MI patients across the United States.

Methods: Using Optum's de-identified Clinformatics Data Mart Database, cardiovascular procedures, physician services, and prescriptions within 6 months postdischarge were compared among patients with T2MI vs type 1 myocardial infarction (T1MI) between October 1, 2017, and June 30, 2020. Multivariable logistic regression examined the odds of resource utilization in T2MI vs T1MI and identified predictors of utilization for T2MI.

Results: We identified 140,344 patients with myocardial infarction; 121,738 patients (87%) had T1MI and 18,606 (13%) had T2MI. All participants had 183 days of postdischarge follow-up. Within 6 months postdischarge, patients with T2MI were significantly less likely to fill new prescriptions for P2Y₁₂ inhibitors (4.8% [603/14,176] vs 52.8% [44,833/99,593], adjusted OR: 0.28; 95% CI: 0.25-0.31), beta blockers (27.1% [2,070/14,176] vs 62.8% [38,219/99,593], OR: 0.59; 95% CI: 0.55-0.63), statins (19.1% [1,439/14,176] vs 59.1% [32,434/99,593], OR: 0.51; 95% CI: 0.47-0.55), and SGLT2i or glucagon-like peptide-1 agonists (4.8% [595/14,176] vs 35.4% [30,202/99,593], OR: 0.30; 95% CI: 0.27-0.33) as compared to T1MI. Patients with T2MI were significantly less likely to undergo an echocardiogram (71.8% [10,179/14,176] vs 82.9% [82,551/99,593], OR: 0.61; 95% CI: 0.58-0.64) and coronary angiogram (11.7% [1,664/14,176] vs 76.6% [76,327/99,593], OR: 0.10; 95% CI: 0.09-0.11) compared to T1MI.

Conclusions: In the United States, T2MI patients received less cardiovascular testing and secondary preventative therapies than T1MI patients.

Keywords: cardioprotective medications; diagnostic testing; revascularization; type 1 myocardial infarction (T1MI); type 2 myocardial infarction (T2MI).

Grants and funding

K23 HL167659/HL/NHLBI NIH HHS/United States