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Revisiting type 2 myocardial infarction: Unmet clinical needs
Andrea Palermi1, Silvio Saraullo1, Maria Bernadette Giordano1
1Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy.
Current Problems in Cardiology
|August 9, 2025
Summary
Differentiating acute myocardial infarction (AMI) subtypes, type 1 (T1MI) and type 2 (T2MI), is crucial. Identifying coronary artery disease (CAD) in T2MI guides treatment and improves outcomes for this high-risk group.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Cardiovascular disease is a leading cause of global mortality.
- Acute coronary syndrome (ACS) often presents as the initial manifestation.
- Myocardial infarction (MI) diagnosis relies on the fourth universal definition, distinguishing subtypes like T1MI and T2MI.
Purpose of the Study:
- To delineate the clinical features, imaging, and biomarker differences between T1MI and T2MI.
- To emphasize the significant role of coronary artery disease (CAD) in T2MI.
- To refine the diagnostic-therapeutic algorithm for T2MI, particularly concerning CAD presence.
Main Methods:
- Narrative review of existing literature.
- Analysis of diagnostic criteria for T1MI and T2MI.
- Exploration of the impact of CAD on T2MI pathophysiology and prognosis.
Main Results:
- T1MI results from plaque disruption and athero-thrombosis.
- T2MI stems from myocardial oxygen supply-demand imbalance, independent of acute athero-thrombosis.
- CAD presence and severity are critical factors influencing T2MI risk and patient eligibility for reperfusion strategies.
Conclusions:
- Accurate differentiation between T1MI and T2MI is essential for appropriate management.
- Identifying CAD in T2MI patients is key to tailoring reperfusion strategies and secondary prevention.
- Further research into CAD's role in T2MI can optimize patient outcomes.
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