Fournier Victor, Nazeyrollas Pierre, Lefebvre Corentin, Metz Damien, Faroux Laurent
Cardiology, Centre Hospitalier Universitaire (CHU) Robert Debré, Reims, FRA.
UFR (Training and Research Unit) Sciences, Université de Reims Champagne-Ardenne, Reims, FRA.
Cureus. 2025 Apr 28;17(4):e83137. doi: 10.7759/cureus.83137. eCollection 2025 Apr.
Introduction Type 2 acute coronary syndrome (ACS) is defined as myocardial infarction caused by an imbalance between myocardial oxygen supply and demand. Although several observational studies have been conducted, they have not led to the development of clear clinical guidelines, partly due to heterogeneous definitions and the absence of consensus regarding diagnostic criteria and management strategies. Aims To assess diagnostic practices and management of type 2 ACS in patients without pre-existing heart disease and to analyze these practices based on the availability of coronary angiography at the inclusion center. Methods We retrospectively reviewed the records of 25,225 patients who received a troponin assay in the emergency departments of two centers, one with and the other without coronary angiography facilities, from 2018 to 2019. We selected 224 patients without pre-existing heart disease who had type 2 ACS according to objective criteria. The study was designed as a retrospective, descriptive, and comparative analysis. Data on clinical characteristics, diagnostic labeling, and management strategies, including cardiology consultations and ischemic investigations, were collected and analyzed. Results The study populations from both centers were similar. Clinicians diagnosed type 2 ACS in only three (1.3%) cases, despite a high rate of cardiology consultations (180, 80.4%). Exploration was performed in 78 (34.8%) patients, revealing significant coronary lesions in 43 (64.2%) cases. In 118 (74.7%) patients without exploration during hospitalization, no rationale was documented. The presence of on-site coronary angiography did not significantly influence the decision to explore (p = 0.067). Exploration decisions were influenced by age (p < 0.001), family history (p = 0.006), ECG presentation (p = 0.034), left ventricular ejection fraction (LVEF) (p = 0.02), and cardiology consultation request (p < 0.001). Conclusion Objective criteria allowed the selection of a homogeneous type 2 ACS population. The diagnosis is rarely made, highlighting the need for increased awareness among emergency physicians and cardiologists. Integrating objective criteria into clinical guidelines could be considered. Given the high rate of underlying coronary lesions, patients with type 2 ACS and no pre-existing heart disease should be prioritized for coronary exploration.
引言 2型急性冠状动脉综合征（ACS）被定义为由心肌氧供需失衡引起的心肌梗死。尽管已经开展了多项观察性研究，但尚未形成明确的临床指南，部分原因是定义不统一以及在诊断标准和管理策略方面缺乏共识。目的 评估无既往心脏病患者2型ACS的诊断实践和管理情况，并根据纳入中心冠状动脉造影的可及性分析这些实践。方法 我们回顾性分析了2018年至2019年在两个中心急诊科接受肌钙蛋白检测的25225例患者的记录，其中一个中心有冠状动脉造影设备，另一个中心没有。我们根据客观标准选择了224例无既往心脏病且患有2型ACS的患者。该研究设计为回顾性、描述性和对比分析。收集并分析了临床特征、诊断标签和管理策略的数据，包括心脏病会诊和缺血性检查。结果 两个中心的研究人群相似。尽管心脏病会诊率很高（180例，80.4%），但临床医生仅诊断出3例（1.3%）2型ACS。78例（34.8%）患者进行了检查，其中43例（64.2%）发现有显著冠状动脉病变。在118例（74.7%）住院期间未进行检查的患者中，未记录理由。现场冠状动脉造影的存在对检查决策没有显著影响（p = 0.067）。检查决策受年龄（p < 0.001）、家族史（p = 0.006）、心电图表现（p = 0.034）、左心室射血分数（LVEF）（p = 0.02）和心脏病会诊请求（p < 0.001）影响。结论 客观标准有助于选择同质化的2型ACS人群。该诊断很少做出，凸显了提高急诊科医生和心脏病专家认识的必要性。可考虑将客观标准纳入临床指南。鉴于潜在冠状动脉病变的高发生率，对于无既往心脏病的2型ACS患者，应优先进行冠状动脉探查。
