Type 2 myocardial infarction: the chimaera of cardiology?

Abstract

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.

Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury

“…However, the distinction between type 2 MI and NIMI (the latter having additional implications for the psychosocial environment of the patient) has not led to the development of rigorously tested therapeutic strategies or procedures aimed at improving their mid-term or short-term prognosis. For this reason, in agreement with other authors,29 30 we believe that a review of the current nomenclature of MI is essential to ensuring the homogeneity of clinical studies and thus a thoughtful understanding of this clinical entity.…”

Cardiac troponins and mortality in type 1 and 2 myocardial infarction

“…the optimal therapy depends on the underlying cause of the supply-demand mismatch). Indeed, coronary angiography is now regarded as the mainstay for the differential diagnosis, wherein patients with type 2 MI do not usually present with plaque rupture and/or culprit lesions with thrombosis [23][24][25]. Recent evidence also attests that the clinical presentation may be partially distinctive between these two types of MI, but signs and symptoms do not allow to reach a definitive diagnosis [7].…”

Contemporary and Future Usage of Conventional Cardiac Biomarkers: A Novel Algorithm for the Early Diagnosis of AMI and CVA

“…The specificity of the type of MI, using hs-Tn assays, has caused confusion amongst clinicians and caused unnecessary workups in hospitals, especially in type-II MI (demand ischemia) [45,46]. We suggest the use of serial CK-MB assays for increased specificity in diagnosing MI (type-I vs. type-II), infarct sizing, and reinfarction.…”