Author + information
- Received August 21, 2018
- Revision received January 29, 2019
- Accepted February 4, 2019
- Published online April 8, 2019.
- aDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- bDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Allan S. Jaffe, Department of Cardiovascular Diseases and Department of Laboratory Medicine and Pathology, Mayo Clinic, Gonda 468, 200 1st, SW, Rochester, Minnesota 55905.
• T2MI occurs due to myocardial oxygen supply/demand mismatch without acute atherothrombotic plaque disruption and is associated with adverse short- and long-term prognoses.
• T2MI is a heterogeneous entity usually caused by a noncoronary trigger. Individualized care is needed.
• Consensus is needed about diagnosis. Imaging may help characterize processes leading to myocardial injury, facilitate the identification of acute myocardial ischemia, and help distinguish MI from injury.
Acute myocardial infarction (MI) can occur from increased myocardial oxygen demand and/or reduced supply in the absence of acute atherothrombotic plaque disruption; a condition called type 2 myocardial infarction (T2MI). As with any MI subtype, there must be clinical evidence of myocardial ischemia to make the diagnosis. This condition is increasingly diagnosed due to the increasing sensitivity of cardiac troponin assays and is associated with adverse short-term and long-term prognoses. Limited data exist defining optimal management strategies because T2MI is a heterogeneous entity with varying etiologies and triggers. Thus, these patients require individualized care. A major barrier is the absence of a uniform definition that can be operationalized with high reproducibility. This document provides a synthesis of the data about T2MI to assist clinicians’ understanding of its pathobiology, when to deploy the diagnosis, and its associated treatments. It also clarifies prognosis, identifies gaps in knowledge, and provides recommendations for moving forward.
- acute myocardial infarction
- cardiac troponin
- myocardial injury
- type 2 myocardial infarction
- Universal Definition of Myocardial Infarction
Dr. Sandoval has served on the Advisory Board of Abbott Diagnostics without personal compensation; and has served as a nonsalaried advisor for Roche Diagnostics. Dr. Jaffe has consulted or is presently consulting for most of the major diagnostic companies, including Beckman, Abbott, Siemens, ET Healthcare, Roche, Quidel, Sphingotec, and Novartis.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received August 21, 2018.
- Revision received January 29, 2019.
- Accepted February 4, 2019.
- 2019 American College of Cardiology Foundation
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