Type 2 myocardial infarction--Diagnosis, prognosis, and treatment

Myocardial infarction (MI) can have a number of underlying causes, with the Task Force for the Redefinition of MI in 2007 narrowing the condition down to five subtypes. Among them is type 2 MI, which is characterized by a myocardial oxygen supply and demand mismatch that is mediated by something other than coronary artery disease.

Myocardial infarction (MI) can have a number of underlying causes, with the Task Force for the Redefinition of MI in 2007 narrowing the condition down to five subtypes. Among them is type 2 MI, which is characterized by a myocardial oxygen supply and demand mismatch that is mediated by something other than coronary artery disease. Some sources maintain that type 2 MI has become more prevalent than type 1 MI—or spontaneous infarction—yet there is little in the way of existing high-quality evidence on type 2 MI from prospective trials, and there are no guidelines or consensus documents to help inform clinical management. The incidence of type 2 MI is expected to only increase going forward, especially with high-sensitivity troponin assays now being widely used in the United States for diagnostic purposes. At the same time, the outlook for type 2 MI patients—which often strikes older adults with comorbidities—is poor. In light of this information, researchers at Brigham & Women's Hospital and Massachusetts General Hospital, both in Boston, write that much more must be done to better define type 2 MI, to better understand its biological pathway, and to identify effective management approaches. Otherwise, they conclude, this increasingly common diagnosis will continue to suffer a lack of effective strategies to lower the associated risk of death.