Most patients presenting with spontaneous myocardial infarction (MI) tend to have type 1 MI, characterized by coronary plaque rupture or erosion and superimposed thrombosis. But a substantial proportion have type 2 MI, characterized by an imbalance between myocardial oxygen supply and demand, precipitated by an extracardiac stressor, such as hypertension, tachycardia, or hypotension.
Differentiating between type 1 and type 2 MI is clinically important because the therapeutic focus differs. For patients with type 1 MI, the focus is on aggressive antithrombotic therapy and consideration of urgent coronary angiography and revascularization. For patients with type 2 MI, the focus is on treating the extracardiac stressor precipitating the myocardial oxygen supply and demand imbalance.
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Sabatine MS. Differentiating Type 1 and Type 2 Myocardial Infarction: Unfortunately, Still More Art Than Science. JAMA Cardiol. Published online April 21, 2021. doi:10.1001/jamacardio.2021.0693
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