Coronary disease & ACSCohort study
Causal Endotype–Based Classification of Myocardial Infarction
- Prospective multicentre registry cohort study
- consecutive patients
Authors' conclusion
In this study, a causal endotype-based classification of MI identified distinct underlying mechanisms and clinical profiles that were not fully captured by the type 1/type 2 framework.
Study context
- Population
- Consecutive patients with adjudicated type 1 or 2 myocardial infarction (MI) (fourth universal definition of myocardial infarction (UDMI)), AMIPE registry, 2017–2023
- Participants
- 6,282 patients
- Exposure
- MI causal endotypes: cardiac/noncoronary, systemic, indeterminate vs cardiac/coronary
- Cardiac/coronaryn = 5,330reference
- Cardiac/noncoronaryn = 302
- Systemicn = 503
- Indeterminaten = 147
- Outcome
- Distribution of causal endotypes and underlying etiologies
Main finding
As reported in the abstract
Distribution of causal endotypes
Observational data: associations, not effects.
Further findings
| Outcome | Cardiac/coronary | Cardiac/noncoronary | Systemic | Indeterminate | adjusted HR (95% CI) | |
|---|---|---|---|---|---|---|
| All-cause mortality · 1 year — Cardiac/noncoronary vs Cardiac/coronary | 9.8% | 15.9% | 25.8% | 1.4% | 1.46 (1.08–1.96) | |
| All-cause mortality · 1 year — Systemic vs Cardiac/coronary | 2.50 (2.05–3.05) | |||||
| All-cause mortality · 1 year — Indeterminate vs Cardiac/coronary | 0.22 (0.06–0.89) | |||||
| 0.050.21520Adjusted hazard ratio (log scale) |
All-cause mortality · 1 year
- Higher mortality in systemic and cardiac/noncoronary MI largely related to noncardiovascular death
MACE and recurrent MI · 1 year
- MACE rates differed less markedly across endotypes
- Recurrent MI less frequent in cardiac/noncoronary and systemic than cardiac/coronary MI
Original publication
Causal Endotype–Based Classification of Myocardial Infarction. JAMA Cardiol. Published 29 August 2026. doi:10.1001/jamacardio.2026.3794
Summarised from the published abstract; every number is checked against it