title: Provoking conditions, management and outcomes of type 2 myocardial infarction and myocardial necrosis.
abstract: BACKGROUND
  Type 2 myocardial infarction (MI) is defined as myocardial necrosis (myonecrosis) due to an imbalance in supply and demand with clinical evidence of ischemia. Some clinical scenarios of supply-demand mismatch predispose to myonecrosis but limit the identification of symptoms and ECG changes referable to ischemia; therefore, the MI definition may not be met. Factors that predispose to type 2 MI and myonecrosis without definite MI, approaches to treatment, and outcomes remain poorly characterized.
  
  
  METHODS
  Patients admitted to an academic medical center with an ICD-9 diagnosis of secondary myocardial ischemia or non-primary diagnosis of non-ST-elevation MI were retrospectively reviewed. Cases were classified as either MI (n=255) or myonecrosis without definite MI (n=220) based on reported symptoms, ischemic ECG changes, and new wall motion abnormalities.
  
  
  RESULTS
  Conditions associated with type 2 MI or myonecrosis included non-cardiac surgery (38%), anemia or bleeding requiring transfusion (32%), sepsis (31%), tachyarrhythmia (23%), hypotension (22%), respiratory failure (23%), and severe hypertension (8%). Inpatient mortality was 5%, with no difference between patients with MI and those with myonecrosis (6% vs. 5%, p=0.41). At discharge, only 43% of patients received aspirin and statin therapy.
  
  
  CONCLUSIONS
  Type 2 MI and myonecrosis occur frequently in the setting of supply-demand mismatch due to non-cardiac surgery, sepsis, or anemia. Myonecrosis without definite MI is associated with similar in-hospital mortality as type 2 MI; both groups warrant further workup for cardiovascular disease. Antiplatelet and statin prescriptions were infrequent at discharge, reflecting physician uncertainty about the role of secondary prevention in these patients.
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Smilowitz
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Weiss
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Rina
authors.initials: R
authors.lastname: Mauricio
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Asha M
authors.initials: AM
authors.lastname: Mahajan
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Kaitlyn E
authors.initials: KE
authors.lastname: Dugan
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Arvind
authors.initials: A
authors.lastname: Devanabanda
authors.affiliation: Division of Clinical Research Informatics, New York University School of Medicine, New York, NY, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Pulgarin
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Gianos
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA; Section of Cardiology, Department of Medicine, New York Harbor Health Care System, Veterans Affairs Hospital, New York, NY, USA.
authors.forename: Binita
authors.initials: B
authors.lastname: Shah
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA; Section of Cardiology, Department of Medicine, New York Harbor Health Care System, Veterans Affairs Hospital, New York, NY, USA.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Radford
authors.affiliation: Cardiovascular Clinical Research Center, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: harmony.reynolds@nyumc.org.
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin
keywords: Myocardial infarction; Myocardial injury; Myocardial ischemia; Myocardial necrosis; Risk factor; Secondary prevention