Clinical characteristics, aetiology and occurrence of type 2 acute myocardial infarction

Szymański, Filip M.; Karpiński, Grzegorz; Płatek, Anna E.; Majstrak, Franciszek; Hrynkiewicz−Szymańska, Anna; Kotkowski, Marcin; Puchalski, Bartosz; Filipiak‬, Krzysztof J.; Opolski, Grzegorz

doi:10.5603/kp.a2013.0284

Cited by 43 publications

(25 citation statements)

References 18 publications

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“…90% stenosis in left main coronary artery in this case indicated a strong correlation between the stenosis and the extensive transmural ischemia. It is also reported in another study that extensive transmural ischemia could cause ventricular arrhythmia [1]. All the evidences supported that multimorphologic ventricular tachycardia was correlated with myocardial ischemia.…”

Section: Discussionsupporting

confidence: 64%

Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

Zheng

Liu

et al. 2015

Case Reports in Medicine

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Patients with acute coronary syndrome (ACS) rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG) revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0∗18 mm and 2.75∗18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI). The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

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Section: Discussionsupporting

confidence: 64%

Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

Zheng

Liu

et al. 2015

Case Reports in Medicine

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“…In reality, the diagnosis of type 2 MI as defined by troponin elevation can only be associated with another clinical condition as a pathophysiology is not defined. In two studies in the literature, evidence of significant coronary artery disease (CAD) has been required for making the diagnosis of type 2 MI,35 42 although that is not an obligatory part of the definition that was proposed in the universal definition of MI 21 22. There has been no study to date where all patients had their coronary anatomy defined prior to classification into type 1 or type 2 MI.…”

mentioning

confidence: 99%

Type 2 myocardial infarction: the chimaera of cardiology?

Collinson

Lindahl

2015

Heart

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The term type 2 myocardial infarction first appeared as part of the universal definition of myocardial infarction. It was introduced to cover a group of patients who had elevation of cardiac troponin but did not meet the traditional criteria for acute myocardial infarction although they were considered to have an underlying ischaemic aetiology for the myocardial damage observed. Since first inception, the term type 2 myocardial infarction has always been vague. Although attempts have been made to produce a systematic definition of what constitutes a type 2 myocardial infarction, it has been more often characterised by what it is not rather than what it is. Clinical studies that have used type 2 myocardial infarction as a diagnostic criterion have produced disparate incidence figures. The range of associated clinical conditions differs from study to study. Additionally, there are no agreed or evidence-based treatment strategies for type 2 myocardial infarction. The authors believe that the term type 2 myocardial infarction is confusing and not evidence-based. They consider that there is good reason to stop using this term and consider instead the concept of secondary myocardial injury that relates to the underlying pathophysiology of the primary clinical condition.

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“…A key finding of this review is that the clinical characteristics of patients with T2MI, which were similar to those of found by Gupta et al Patients with T2MI were older, more often men, more frequently presented with NSTEMI, and had a higher prevalence of cardiovascular risk factors or comorbidities, such as hypertension, smoking, dyslipidemia, diabetes, obesity, heart failure, impaired renal function, anemia, coronary artery disease, atrial fibrillation, cancer, peripheral artery disease, and chronic obstructive pulmonary disease. In this review, most selected studies revealed that the number of men with T2MI was higher than that of women, while a reduced number of studies found the opposite . For example, Gupta et al described T2MI was more common in females compared with T1MI .…”

Section: Discussionmentioning

confidence: 87%

“…The baseline clinical characteristics and treatment of patients with T2MI are summarized in Table . The mean age of patients with T2MI was over 60 years; most studies revealed that the percentage of male patients ranged from 52.8% to 98.6% in patients with T2MI, but the studies of Szymariski et al, Sandoval et al, and Arora et al found percentages of female patients of 60.3%, 59%, and 51.9%, respectively . The ratio of patients with T2MI presenting with non‐ST segment elevation myocardial infarction (NSTEMI) ranged from 70.1% to 97.5% (mean value: 87.1%); all studies found that patients with T2MI often had previous relevant medical history, but EI‐Haddad et al did not describe medical history findings .…”

Section: Resultsmentioning

confidence: 99%

A systematic review on the triggers and clinical features of type 2 myocardial infarction

Wang

Zhao

Zhong

et al. 2019

Clinical Cardiology

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Little is known about the correlation between triggering factors, clinical characteristics, diagnosis, and prognosis of patients with type 2 myocardial infarction (T2MI). The triggers and features of T2MI are linked to its diagnosis and prognosis. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed. A structured search of three databases (PubMed, Embase, and Medline) was undertaken to identify peer‐reviewed articles related to the triggers and clinical features of T2MI published between January 2012 and August 2018. Seven retrospective cohort studies and seven prospective cohort studies involving 3867 patients with T2MI were included. All selected studies were rated as being of high or acceptable quality. Nine studies revealed that the leading trigger of T2MI was arrhythmia, especially tachyarrhythmia. Six studies revealed that the proportion of single‐trigger T2MIs was higher than that of multiple triggers and two studies showed that two‐trigger cases formed the majority of multiple trigger cases. All included studies found that a greater prevalence of T2MI in the older population. Thirteen studies revealed that the patients with T2MI often had a previous relevant medical history. The leading trigger of T2MI is arrhythmia, especially tachyarrhythmia, and the majority of cases arise from a single trigger. Two‐trigger is the most common form of multiple‐trigger T2MI, which often occurs in older patients with cardiovascular risk factors or comorbidities. Non‐cardiovascular causes may be the triggering factors and are strongly associated with the diagnosis, treatment, and prognosis of T2MI.

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Clinical characteristics, aetiology and occurrence of type 2 acute myocardial infarction

Abstract: Type 2 AMI patients were more often female, and they were more often diagnosed as non-ST-segment elevation MI. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. The leading cause of AMI was coronary artery spasm.

Cited by 43 publications

References 18 publications

Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

Type 2 myocardial infarction: the chimaera of cardiology?

A systematic review on the triggers and clinical features of type 2 myocardial infarction

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