Myocardial infarction type 2 and myocardial injury: The current state of the problem

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Today, the most difficult in terms of diagnosis and treatment today among various types of myocardial infarction (MI) is MI type 2 (MI-2). The lack of clinical guidelines for management of patients with this type of MI, as well as the literature data on prevalence, patient characteristics and prognosis contributes to the scientific relevance of the further research.

Full Text

Restricted Access

About the authors

Dmitriy V. Oblavatskiy

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
ORCID iD: 0000-0003-1628-0193


Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067

Svetlana A. Boldueva

North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0002-1898-084X
SPIN-code: 3716-3375

MD, Professor

Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067

Mariya V. Solovyeva

North-Western State Medical University named after I.I. Mechnikov

ORCID iD: 0000-0002-3335-4986
SPIN-code: 2086-5811


Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067


  1. Thygesen K, Alpert JS, White HD, et al. Universal definition of myocardial infarction. Eur Heart J. 2007;28(20):2525–2538. doi: 10.1093/eurheartj/ehm355
  2. Sandoval Y, Thygesen K. Myocardial infarction type 2 and myocardial injury. Clin Chem. 2017;63(1):101–107. doi: 10.1373/clinchem.2016.255521
  3. Zhelnov VV, Dyatlov NV, Dvoretskiy LI. Myocardial infarction type 2: myth or reality? Arkhiv vnutrenney meditsiny. 2016;6(2(28)):34–41. doi: 10.20514/2226-6704-2016-6-2-34-41
  4. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction. Russian Journal of Cardiology. 2019;24(3):107–138. doi: 10.15829/1560-4071-2019-3-107-138
  5. Mihatov N, Januzzi JL Jr, Gaggin HK. Type 2 myocardial infarction due to supply-demand mismatch. Trends Cardiovasc Med. 2017;27(6):408–417. doi: 10.1016/j.tcm.2017.03.002
  6. Smilowitz NR, Weiss MC, Mauricio R, et al. Provoking conditions, management and outcomes of type 2 myocardial infarction and myocardial necrosis. Int J Cardiol. 2016;218:196–201. doi: 10.1016/j.ijcard.2016.05.045
  7. Kuznetsova OYu, Dubikaitis TA, Frolova EV, et al. he classification of acute myocardial infarction types and the preconditions for its development. Type II myocardial infarction. Russian family doctor. 2017;21(3):5–15. (In Russ.). doi: 10.17816/RFD201735-15
  8. Agewall S, Giannitsis E, Jernberg T, Katus H. Troponin elevation in coronary vs. non-coronary disease. Eur Heart J. 2011;32(4):404–411. doi: 10.1093/eurheartj/ehq456
  9. Masri W, Le Guillou E, Hamdi E, et al. Troponin elevation in other conditions than acute coronary syndromes. Ann Biol Clin (Paris). 2017;75(4):411–419. doi: 10.1684/abc.2017.1262
  10. Eggers KM, Lindahl B. application of cardiac troponin in cardiovascular diseases other than acute coronary syndrome. Clin Chem. 2017;63(1):223–235. doi: 10.1373/clinchem.2016.261495
  11. Sarkisian L, Saaby L, Poulsen TS, et al. Clinical characteristics and outcomes of patients with myocardial infarction, myocardial injury, and nonelevated troponins. Am J Med. 2016;129(4):446e.5–446e.21. doi: 10.1016/j.amjmed.2015.11.006
  12. Brinkmann C, Schofer J. 4th universal definition of myocardial infarction 2018: What is new? Herz. 2018;43(8):681–688. doi: 10.1007/s00059-018-4763-6. (In German)
  13. Chapman AR, Shah ASV, Lee KK, et al. Long-term outcomes in patients with type 2 myocardial infarction and myocardial injury. Circulation. 2018;137(12):1236–1245. doi: 10.1161/circulationaha.117.031806
  14. Saaby L, Poulsen TS, Hosbond S, et al. Classification of myocardial infarction: frequency and features of type 2 myocardial infarction. Am J Med. 2013;126(9):789–797. doi: 10.1016/j.amjmed.2013.02.029
  15. Stein GY, Herscovici G, Korenfeld R, et al. Type-II myocardial infarction – patient characteristics, management and outcomes. PLoS One. 2014;9(1):e84285. doi: 10.1371/journal.pone.0084285
  16. Greenslade JH, Adikari T, Mueller C, et al. Characteristics and occurrence of type 2 myocardial infarction in emergency department patients: a prospective study. Emerg Med J. 2018;35(3):169–175. doi: 10.1136/emermed-2017-206869
  17. McCarthy CP, Murphy S, Cohen JA, et al. Sex differences in patient characteristics, treatment strategies, and outcomes for type 2 myocardial infarction . J Am Coll Cardiol. 2019;(73)24:3230–3233. doi: 10.1016/j.jacc.2019.04.016
  18. Chapman AR, Adamson PD, Mills NL. Assessment and classification of patients with myocardial injury and infarction in clinical practice. Heart. 2017;103(1):10–18. doi: 10.1136/heartjnl-2016-309530
  19. Melberg T, Burman R, Dickstein K. The impact of the 2007 ESC-ACC-AHA-WHF Universal definition on the incidence and classification of acute myocardial infarction: a retrospective cohort study. Int J Cardiol. 2010;139(3):228–233. doi: 10.1016/j.ijcard.2008.10.021
  20. McCarthy CP, Vaduganathan M, Januzzi JL Jr. Type 2 Myocardial infarction-diagnosis, prognosis, and treatment. JAMA. 2018;320(5):433–434. doi: 10.1001/jama.2018.7125
  21. Zharskiy SL. Type 2 Myocardial Infarction: the current state of the problem. Far East Medical Journal. 2016;3:134–138. (In Russ.)
  22. Neumann JT, Sörensen NA, Rübsamen N, et al. Discrimination of patients with type 2 myocardial infarction. Eur Heart J. 2017;38(47):3514–3520. doi: 10.1093/eurheartj/ehx457
  23. Collinson P, Lindahl B. Type 2 myocardial infarction: the chimaera of cardiology? Heart. 2015;101(21):1697–1703. doi: 10.1136/heartjnl-2014-307122
  24. Spatz ES, Curry LA, Masoudi FA, et al. The variation in recovery: role of gender on outcomes of young AMI patients (VIRGO) classification system: a taxonomy for young women with acute myocardial infarction. Circulation. 2015;132(18):1710–1718. doi: 10.1161/CIRCULATIONAHA.115.016502
  25. Arora S, Cavender MA, Chang PP. Outcomes of decreasing versus increasing cardiac troponin in patients admitted with non-ST-segment elevation myocardial infarction: the atherosclerosis risk in communities surveillance study. Eur Heart J Acute Cardiovasc Care. 2019:2048872619842983. doi: 10.1177/2048872619842983. Online ahead of print.
  26. Sandoval Y, Smith SW, Sexter A, et al. Use of objective evidence of myocardial ischemia to facilitate the diagnostic and prognostic distinction between type 2 myocardial infarction and myocardial injury. Eur Heart J Acute Cardiovasc Care. 2020;9(1):62–69. doi: 10.1177/2048872618787796
  27. Kolodgie FD, Virmani R, Finn AV, Romero ME. Embolic myocardial infarction as a consequence of atrial fibrillation: a prevailing disease of the future. Circulation. 2015;132(4):223–226. doi: 10.1161/CIRCULATIONAHA.115.017534
  28. Sandoval Y, Smith SW, Thordsen SE, Apple FS. Supply/demand type 2 myocardial infarction: should we be paying more attention? J Am Coll Cardiol. 2014;63(20):2079–2087. doi: 10.1016/j.jacc.2014.02.541
  29. Agewall S, Beltrame JF, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017;38(3):143–153. doi: 10.1093/eurheartj/ehw149
  30. Niccoli G, Scalone G, Crea F. Acutemyocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management. Eur Heart J. 2015;36(8):475–481. doi: 10.1093/eurheartj/ehu469
  31. Alpert JS, Thygesen KA, White HD, Jaffe AS. Diagnostic and therapeutic implications of type 2 myocardial infarction: review and commentary. Am J Med. 2014;127(2):105–108. doi: 10.1016/j.amjmed.2013.09.031
  32. Nestelberger T, Boeddinghaus J, Badertscher P, et al. Effect of definition on incidence and prognosis of type 2 myocardial infarction. J Am Coll Cardiol. 2017;70(13):1558–1568. doi: 10.1016/j.jacc.2017.07.774
  33. Thygesen K, Jaffe AS. Detecting myocardial infarction type 2: targetting the right patients. Eur Heart J. 2017;38(47):3521–3522. doi: 10.1093/eurheartj/ehx557
  34. Radovanovic D, Pilgrim T, Seifert B, et al. Type 2 myocardial infarction: incidence, presentation, treatment and outcome in routine clinical practice. J Cardiovasc Med (Hagerstown). 2017;18(5):341–347. doi: 10.2459/JCM.0000000000000504
  35. Smilowitz NR, Subramanyam P, Gianos E, et al. Treatment and outcomes of type 2 myocardial infarction and myocardial injury compared with type 1 myocardial infarction. Coron Artery Dis. 2018;29(1):46–52. doi: 10.1097/MCA.0000000000000545
  36. Cediel G, Sandoval Y, Sexter A, et al. Risk estimation in type 2 myocardial infarction and myocardial injury: the tarraco risk score. Am J Med. 2019;132(2):217–226. doi: 10.1016/j.amjmed.2018.10.022
  37. Cediel G, Gonzalez-Del-Hoyo M, Carrasquer A, et al. Outcomes with type 2 myocardial infarction compared with non-ischaemic myocardial injury. Heart. 2017;103(8):616–622. doi: 10.1136/heartjnl-2016-310243
  38. Lambrecht S, Sarkisian L, Saaby L, et al. Different causes of death in patients with myocardial infarction type 1, type 2, and myocardial injury. Am J Med. 2018;131(5):548–554. doi: 10.1016/j.amjmed.2017.11.043

Supplementary files

There are no supplementary files to display.

Copyright (c) 2021 Oblavatskiy D.V., Boldueva S.A., Solovyeva M.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 71733 от 08.12.2017.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies