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The Many Faces of Type 2 Myocardial Infarction ∗
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2017-09-01 , DOI: 10.1016/j.jacc.2017.07.784
James L Januzzi 1 , Yader Sandoval 2
Affiliation  

SEE PAGE 1558 C linicians have long recognized that acute myocardial infarction (MI) can occur in the absence of atherothrombosis (1). The Universal Definition of MI Global Taskforce introduced a classification system in 2007 (and reaffirmed in 2012) that defined type 2 MI (following standard diagnostic criteria) as MI occurring due to an imbalance in myocardial oxygen supply and/or demand not caused by atherosclerotic plaque disruption (2,3) (Table 1). Nevertheless, ambiguity remains regarding how to diagnose type 2 MI and how to distinguish it from both type 1 MI and myocardial injury (4,5). For example, because thosewith type 2MI are less likely to have chest pain, studies focusing onpatientswith chest discomfort have a higher prevalence of type 1 MI, whereas in studies of hospitalized patients with another medical illness, type 2 MI predominates. Patients with type 2 MI presenting with acute chest pain differ from the more heterogeneous and medically complex cohort of patients having type 2MI in the context of another acute illness, who may have multiple identifiable triggers leading to imbalances inmyocardial oxygen supply and demand; venue, context, and mechanism all matter when classifying type 2 MI (Figure 1). Regardless of the heterogeneity observed across type 2 MI studies, the diagnosis is frequent and far from benign (Table 2) (6–22). Some studies show that

中文翻译:

2 型心肌梗塞的多面性 *

参见第 1558 页 C 临床医生早就认识到,急性心肌梗塞 (MI) 可能在没有动脉粥样硬化血栓形成的情况下发生 (1)。MI 全球工作组的通用定义在 2007 年引入了一个分类系统(并在 2012 年重申),该系统将 2 型 MI(遵循标准诊断标准)定义为由于心肌氧供应和/或需求不平衡而不由动脉粥样硬化斑块引起的 MI中断 (2,3)(表 1)。然而,关于如何诊断 2 型 MI 以及如何将其与 1 型 MI 和心肌损伤区分开来仍存在歧义 (4,5)。例如,由于 2 型心肌梗死患者发生胸痛的可能性较小,因此针对胸部不适患者的研究具有较高的 1 型心肌梗死患病率,而在对患有其他内科疾病的住院患者的研究中,2 型 MI 占主导地位。出现急性胸痛的 2 型心肌梗死患者与其他急性疾病背景下的 2 型心肌梗死患者的异质性和医学复杂程度不同,后者可能有多种可识别的触发因素,导致心肌氧供需失衡;在对 2 型 MI 进行分类时,地点、背景和机制都很重要(图 1)。不管 2 型 MI 研究中观察到的异质性如何,诊断很常见,而且远非良性(表 2)(6-22)。一些研究表明,在对 2 型 MI 进行分类时,上下文和机制都很重要(图 1)。不管 2 型 MI 研究中观察到的异质性如何,诊断很常见,而且远非良性(表 2)(6-22)。一些研究表明,在对 2 型 MI 进行分类时,上下文和机制都很重要(图 1)。不管 2 型 MI 研究中观察到的异质性如何,诊断很常见,而且远非良性(表 2)(6-22)。一些研究表明,
更新日期:2017-09-01
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