Risk factors for type 2 MI: the usual suspects or guilt by association?
Risk factors for type 2 MI: the usual suspects or guilt by association?
复制标题
2 型心肌梗死的危险因素：通常的嫌疑人还是关联罪？
DOI：
10.1093/eurheartj/ehab707
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发表时间：
2022
影响因子：
39.3
通讯作者：
Marston,NicholasA
中科院分区：
文献类型：
--
作者：
O'Donoghue,MichelleL;Marston,NicholasA
在没有急性血栓形成的情况下不匹配。2，3正确的分类具有重要的治疗意义，因为1型MI的短期和长期管理集中在冠状动脉斑块稳定、凝块预防和溶解上，而2型事件的管理传统上集中在其促发因素的治疗上。为此，2型MI反映了非常异质的疾病状态，因为许多情况可能导致心肌需求增加（例如快速性心律失常、高血压急症、败血症和心力衰竭）或心肌供氧减少[例如缺氧、贫血、低血压、冠状动脉疾病（CAD）、血管痉挛、微血管疾病或内皮功能障碍]。尽管有很高比例的2型MI患者被诊断为CAD，但该患者人群中心外膜疾病的真实患病率尚不清楚，因为许多患者在血清肌钙蛋白升高和降低后缺乏诊断性成像的情况下可能被诊断为CAD。更广泛的检测和更灵敏的肌钙蛋白检测的发展可能导致2型MI事件的发生率上升。尽管如此，传统的危险因素是否可能导致2型心肌梗死的风险以及这些危险因素的治疗是否可能带来益处，在很大程度上尚未探讨。
mismatch in the absence of acute thrombosis. 2, 3 Correct classification carries important treatment implications, since the short-and long-term management of a type 1 MI is centred on coronary plaque stabilization, clot prevention, and dissolution, whereas the management of a type 2 event has been traditionally focused toward treatment of its precipitating factors.To that end, type 2 MIs reflect a very heterogeneous disease state, since a myriad of conditions may contribute to both increased myocardial demand (eg tachyarrhythmia, hypertensive urgency, sepsis, and heart failure) or diminished oxygen delivery to the myocardium [eg hypoxia, anaemia, hypotension, coronary artery disease (CAD), vasospasm, microvascular disease, or endothelial dysfunction]. Although a high proportion of patients who experience a type 2 MI carry a diagnosis of CAD, the true prevalence of epicardial disease in this patient population is not known as many may be assigned a diagnosis of CAD in the absence of diagnostic imaging subsequent to a rise and fall in serum troponin. More widespread testing and the development of more sensitive troponin assays have probably contributed to the rising incidence of type 2 MI events. Nonetheless, it remains largely unexplored whether traditional risk factors may contribute to type 2 MI risk and whether treatment of these risk factors may confer benefit.