Chapman Andrew R, Adamson Philip D, Mills Nicholas L
BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Heart. 2017 Jan 1;103(1):10-18. doi: 10.1136/heartjnl-2016-309530. Epub 2016 Nov 2.
Myocardial injury is common in patients without acute coronary syndrome, and international guidelines recommend patients with myocardial infarction are classified by aetiology. The universal definition differentiates patients with myocardial infarction due to plaque rupture (type 1) from those due to myocardial oxygen supply-demand imbalance (type 2) secondary to other acute illnesses. Patients with myocardial necrosis, but no symptoms or signs of myocardial ischaemia, are classified as acute or chronic myocardial injury. This classification has not been widely adopted in practice, because the diagnostic criteria for type 2 myocardial infarction encompass a wide range of presentations, and the implications of the diagnosis are uncertain. However, both myocardial injury and type 2 myocardial infarction are common, occurring in more than one-third of all hospitalised patients. These patients have poor short-term and long-term outcomes with two-thirds dead in 5 years. The classification of patients with myocardial infarction continues to evolve, and future guidelines are likely to recognise the importance of identifying coronary artery disease in type 2 myocardial infarction. Clinicians should consider whether coronary artery disease has contributed to myocardial injury, as selected patients are likely to benefit from further investigation and in these patients targeted secondary prevention has the potential to improve outcomes.
心肌损伤在无急性冠状动脉综合征的患者中很常见，国际指南建议对心肌梗死患者进行病因分类。通用定义将因斑块破裂导致的心肌梗死患者（1型）与继发于其他急性疾病的心肌氧供需失衡导致的患者（2型）区分开来。有心肌坏死但无心肌缺血症状或体征的患者被分类为急性或慢性心肌损伤。这种分类在实践中尚未得到广泛采用，因为2型心肌梗死的诊断标准涵盖了广泛的表现形式，且诊断的意义尚不确定。然而，心肌损伤和2型心肌梗死都很常见，在所有住院患者中超过三分之一的人会发生。这些患者的短期和长期预后较差，5年内三分之二的患者死亡。心肌梗死患者的分类仍在不断演变，未来的指南可能会认识到在2型心肌梗死中识别冠状动脉疾病的重要性。临床医生应考虑冠状动脉疾病是否导致了心肌损伤，因为部分患者可能会从进一步检查中获益，并且在这些患者中进行有针对性的二级预防有可能改善预后。
