{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:49:31Z","timestamp":1792799371839,"version":"4.5.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec id=\"ab-hoi260050-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The fourth universal definition of myocardial infarction (UDMI) distinguishes type 1 from type 2 myocardial infarction (MI), but this framework does not fully capture the heterogeneity of underlying mechanisms and prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260050-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize the distribution and clinical features of MI causal endotypes in a large contemporary cohort with a descriptive assessment of associated 1-year outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260050-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Consecutive patients from the prospective, multicenter AMIPE registry with an adjudicated diagnosis of MI according to the fourth UDMI were included between January 1, 2017, and December 31, 2023. Follow-up was 1 year; patients with available 1-year follow-up or who died within the first year were included. Type 3, 4, and 5 MI and nonischemic myocardial injuries were excluded. These data were analyzed from June 2025 to May 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260050-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Patients were classified according to the primary etiologic mechanism of MI into 4 causal endotypes: cardiac\/coronary, cardiac\/noncoronary, systemic, or indeterminate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260050-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>The main measures were the distribution of causal endotypes and underlying etiologies. One-year outcomes included all-cause death, major adverse cardiovascular events ([MACE] cardiovascular death or recurrent MI), cardiovascular death, and recurrent MI. Cox and Fine-Gray models used the cardiac\/coronary group as reference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260050-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 6282 patients, mean (SD) age was 69.8 (13.5) years and 2013 (32.0%) were women. Overall, 5330 patients (84.9%) had a cardiac\/coronary cause, including 5158 with acute atherothrombosis and 172 with nonatherothrombotic coronary mechanisms, 302 had a cardiac\/noncoronary cause (4.8%), most commonly tachyarrhythmia, 503 had a systemic cause (8.0%), and 147 had an indeterminate cause (2.3%). At 1 year, all-cause mortality was 9.8% in cardiac\/coronary MI, 15.9% in cardiac\/noncoronary MI, 25.8% in systemic MI, and 1.4% in indeterminate MI. Compared with cardiac\/coronary MI, adjusted hazard ratios for all-cause death were 1.46 (95% CI, 1.08-1.96) for cardiac\/noncoronary MI, 2.50 (95% CI, 2.05-3.05) for systemic MI, and 0.22 (95% CI, 0.06-0.89) for indeterminate MI. Higher mortality in systemic and cardiac\/noncoronary MI was largely related to noncardiovascular death. MACE rates differed less markedly across endotypes, whereas recurrent MI was less frequent in cardiac\/noncoronary and systemic MI than in cardiac\/coronary MI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-hoi260050-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this study, a causal endotype\u2013based classification of MI identified distinct underlying mechanisms and clinical profiles that were not fully captured by the type 1\/type 2 framework. This approach may complement the UDMI by improving characterization of MI heterogeneity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamacardio.2026.3794","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T15:30:19Z","timestamp":1788017419000},"page":"951","source":"Crossref","is-referenced-by-count":2,"title":["Causal Endotype\u2013Based Classification of Myocardial Infarction"],"prefix":"10.1001","volume":"11","author":[{"given":"Matteo","family":"Armillotta","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy"},{"name":"Cardiovascular Division, Morgagni-Pierantoni University Hospital, Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Angeli","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of 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