ADding insult to injury: Are there treatments for myocardial injury and type 2 myocardial infarction?

Abstract

The Fourth Universal Definition of Myocardial Infarction was notable for highlighting the importance of myocardial injury.1 It described a plethora of pathophysiologic processes associated with myocardial injury, which was defined by elevation of cardiac troponin (cTn) levels >99th percentile of the normal reference range.1 If the cTn elevations were associated with clinical ischemia (symptoms, ECG changes, or imaging evidence), either type 1 (plaque rupture and thrombus) or type 2 (supply/demand imbalance) myocardial infarction (MI) should be diagnosed. Myocardial injury may be acute, with a rise and/or fall of cTn levels, or chronic, defined as <20% change in cTn levels beyond 48 hours previously. Chronic cTn elevation may occur in patients with stable coronary artery disease (CAD) and additionally reflect the burden of noncardiovascular disease, such as diabetes mellitus or renal disease, which may be causes of adverse outcomes and mortality long-term.