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Editor's Note
April 21, 2021

Differentiating Type 1 and Type 2 Myocardial Infarction: Unfortunately, Still More Art Than Science

Author Affiliations
  • 1Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Deputy Editor, JAMA Cardiology
JAMA Cardiol. 2021;6(7):781. doi:10.1001/jamacardio.2021.0693

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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