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

## TL;DR

Patients with type 2 myocardial infarction receive fewer cardiovascular tests and medications compared to those with type 1 myocardial infarction in the U.S.

## Contribution

This study is the first to compare cardiovascular resource utilization between T2MI and T1MI patients using a large U.S. database.

## Key findings

- T2MI patients were significantly less likely to receive P2Y12 inhibitors, beta blockers, statins, and SGLT2i/GLP-1 agonists.
- T2MI patients were less likely to undergo echocardiograms and coronary angiograms compared to T1MI patients.
- The study highlights disparities in secondary prevention for T2MI patients in the U.S.

## Abstract

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.

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

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.

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.

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