Defining and managing patients with non‐ST‐elevation myocardial infarction: Sorting through type 1 vs other types

Abstract

Advances in cardiovascular (CV) imaging, redefined electrocardiogram criteria, and high‐sensitivity CV biomarker assays have enabled more differentiated etiological classification of myocardial infarction (MI). Type 1 MI has a different underlying pathophysiology than type 2 through type 5 MI; type 1 MI is characterized primarily by intracoronary atherothrombosis and the other types by a variety of mechanisms, which can occur with or without an atherosclerotic component. In type 2 MI, there is evidence of myocardial oxygen supply‐demand imbalance unrelated to acute coronary atherothrombosis. Types 1 and 2 MI are spontaneous events, while type 4 and type 5 are procedure‐related; type 3 MI is identified only after death. Most type 1 and type 2 MI present as non‐ST‐elevation MI (NSTEMI), although both types can also present as ST‐elevation MI. Because of their different underlying etiologies, type 1 and type 2 NSTEMI have different presentation and prognosis and should be managed differently. In this article, we discuss the epidemiology, prognosis, and management of NSTEMI occurring in the setting of underlying type 1 or type 2 pathophysiology. Most NSTEMI (65%–90%) are type 1 MI. Patients with type 2 MI have multiple comorbidities and causes of in‐hospital mortality among these patients are not always CV‐related. It is important to distinguish between type 1 and type 2 NSTEMI early in the clinical course to allow for the use of the most appropriate treatments that will provide the greatest benefit for these patients.

Machine learning enhances the performance of short and long-term mortality prediction model in non-ST-segment elevation myocardial infarction

“…Although this could not explain all the inconsistency because subgroup analysis showed that ML also outperformed GRACE in STEMI in a previous study 11 , the different performances of the ML models between the STEMI and NSTEMI groups may have contributed to the inconsistent findings. The ML models may have higher discrimination in the NSTEMI group than the traditional model because NSTEMI has more heterogeneous clinical and pathological features than STEMI 22 , 23 . STEMI results from a complete thrombotic occlusion of the infarct-related artery, while NSTEMI occurs in more heterogeneous conditions, such as incomplete coronary occlusion, coronary artery spasm, coronary embolism, myocarditis, and others 24 .…”

A Real Pandora’s Box in Pandemic Times: A Narrative Review on the Acute Cardiac Injury Due to COVID-19

“…Total occlusion of a coronary artery induced by an eroded, vulnerable atherosclerotic plaque and the overlying thrombus formation might be a consequence of a hyperinflammatory environment along with the prothrombotic state induced by SARS-CoV-2 infection. This mechanism represents the basic pathophysiological substrate of ST-elevation myocardial infarction (STEMI) but also accounts for approximately 25% of cases admitted with non-ST-elevation myocardial infarction (NSTEMI) [ 42 , 43 ]. The real epidemiological impact of COVID-19 in patients with cardiac ischemia is mirrored by the worrisome incidence rates of myocardial infarction among SARS-CoV-2 positive cases, ranging from 1.1% to 8.9% [ 44 , 45 ].…”

The Predictive Value of Barthel Score, Sequential Organ Failure Assessment Score, and D-Dimer in the 28-Day Prognosis of Patients with Non-ST Elevation Myocardial Infarction: A Retrospective Study of 358 Patients

“…In recent years, the number of acute myocardial infarction (AMI) patients with non-ST-segment elevation myocardial infarction (NSTEMI) has been increasing. [1][2][3] NSTEMI is characterized by acute onset, hidden disease, many complications, and high mortality rate. Research on related factors affecting the prognosis of the disease has always been a hot spot in this field.…”