Type 1 vs type 2 myocardial infarction

Type 1 MI is the result of atherosclerotic coronary artery disease with thrombotic coronary arterial obstruction secondary to atherosclerotic plaque rupture, ulceration, fissuring, erosion, or dissection.

Type 2 MI is usually related to myocardial necrosis secondary to an increase in myocardial oxygen demand or a decrease in myocardial blood flow.

Type 2 MI occurs when there is an imbalance between the myocardial oxygen supply and demand and is defined as myocardial necrosis in the absence of coronary plaque rupture or erosion.

Troponin levels tend to be higher in patients with type 1 MI compared with those with type 2 MI.

Type 1 MIs on angiograms often found have new or presumably new coronary arterial occlusion or evidence for plaque rupture, fissure, or thrombus within a coronary artery.

The majority of patients who have an MI following noncardiac surgery have type 2 MIs with non-ST elevation myocardial infarction.

A spontaneous MI in the perioperative period with ST elevation is most likely a type 1 MI.

Perioperative MI with hemodynamic changes such as hypotension is probably associated more often with type 2 MI.

Type 2 MI occurs in the setting of an acute medical illness or following a surgical procedure, both are of sufficient significance to cause a decrease in myocardial oxygen supply or an increase in myocardial oxygen demand.

Type 2 MI is often precipitated by hemodynamic instability or hypoxemic respiratory failure.

Patients with type 2 MI differ from patients with type 1 MI that is they are older and have a greater prevalence of comorbidities such as hypertension, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, and prior stroke.

Patients with type 2myocardial infarction, acute nonischemic myocardial injury have a considerably higher long-term risk of death than patients with type one myocardial infarction.

Acute decompensated diabetic patients with type 2 myocardial infarction are at increased risk for death and major adverse cardiac events.

Patients with type two MI  may be more prevalent than patient with type 1MI, and have a higher 30 day readmission rate in patients with type 1 MI, 20% vs 15%.

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