Type 2 MI and Myocardial Injury in the Era of High-sensitivity Troponin

Abstract

Troponin has been the cornerstone of the definition of MI since its introduction to clinical practice. High-sensitivity troponin has allowed clinicians to detect degrees of myocardial damage at orders of magnitude smaller than previously and is challenging the definitions of MI, with implications for patient management and prognosis. Detection and diagnosis are no doubt enhanced by the greater sensitivity afforded by these markers, but perhaps at the expense of specificity and clarity. This review focuses on the definitions, pathophysiology, prognosis, prevention and management of type 2 MI and myocardial injury. The five types of MI were first defined in 2007 and were recently updated in 2018 in the fourth universal definition of MI. The authors explore how this pathophysiological classification is used in clinical practice, and discuss some of the unanswered questions in this era of availability of high-sensitivity troponin.

Klassifikation des Myokardinfarktes

“…Patienten mit Myokardinfarkt Typ 2 sind im Vergleich zu Patienten mit Myokardinfarkt Typ 1 häufiger weiblich und älter [11]. Sie haben zudem öfter Vorerkrankungen, wie chronische Niereninsuffizienz, Anämie, COPD, Herzklappenerkrankungen, Vorhofflimmern und Herzinsuffizienz [6,12]. Dagegen weisen Patienten mit Myokardinfarkt Typ 1 öfter typische kardiovaskuläre Risikofaktoren wie Nikotinabusus und Dyslipidämie auf.…”

“…Unmittelbar zu differenzieren, ob ein Myokardinfarkt Typ 1 oder ein Myokardinfarkt Typ 2 vorliegt, ist deshalb relevant, da beim Myokardinfarkt Typ 1 eine zeitnahe, leitliniengerechte Behandlung die Prognose der Patienten verbessert und die Mortalität senkt [6]. In retrospektiven Untersuchungen erhielten ca.…”

“…Aufgrund der geringen Evidenzlage muss eine solche medikamentöse Therapie jedoch individuell abgewogen werden und kann bspw. bei einer eingeschränkten systolischen LV-Funktion sinnvoll sein [6]. Eine Empfehlung für den Einsatz antithrombozytärer Medikamente bei Typ-2-Infarkten besteht nicht [6,8].…”

Lack of association between the eNOS rs1800779 (A/G) polymorphism and the myocardial infarction incidence among the Iraqi Kurdish population

“…Cardiac biomarkers in predicting death due to MI were previously noted, 18 , 19 but the markers for the prevention of MI remain elusive. Therefore, determining functionally important polymorphisms of the eNOS gene will determine whether a person is prone to MI, and can explain the diverse prevalence of this severe disease in the Kurdish population.…”

Zooming in on the Enigmas of Type 2 Myocardial Infarction

“…here are myriad enigmas related to type 2 myocardial infarction (MI), including the definition, the diagnostic criteria, whether subjective or objective criteria for ischemia should be used, role of imaging, and management. [1][2][3][4] Bularga et al 5 in this issue of Circulation report the prevalence of coronary artery disease (CAD) in a prospective cohort study of 100 patients with type 2 MI.…”