title: Myocardial Infarction Type 2 and Myocardial Injury.
abstract: BACKGROUND
  The development and implementation of sensitive and high-sensitivity cardiac troponin assays has not only expedited the early ruling in and ruling out of acute myocardial infarction, but has also contributed to the identification of patients at risk for myocardial injury with necrosis, as confirmed by the presence of cardiac troponin concentrations above the 99th percentile. Myocardial injury with necrosis may occur either in the presence of overt ischemia from myocardial infarction, or in the absence of overt ischemia from myocardial injury accompanying other conditions. Myocardial infarction type 2 (T2MI) has been a focus of attention; conceptually T2MI occurs in a clinical setting with overt myocardial ischemia where a condition other than an acute atherothrombotic event is the major contributor to a significant imbalance between myocardial oxygen supply and/or demand. Much debate has surrounded T2MI and its interrelationship with myocardial injury.
  
  
  BACKGROUND
  We provide a detailed overview of the current concepts and challenges regarding the definition, diagnosis, management, and outcomes of T2MI, as well as the interrelationship to myocardial injury, and emphasize several critical clinical concepts for both clinicians and researchers moving forward.
  
  
  CONCLUSIONS
  T2MI and myocardial injury are frequently encountered in clinical practice and are associated with poor outcomes in both the short term and long term. Diagnostic strategies to facilitate the clinical distinction between ischemic myocardial injury with or without an acute atheroma-thrombotic event vs non-ischemic-mediated myocardial injury conditions are urgently needed, as well as evidence-based therapies tailored toward improving outcomes for patients with T2MI.
authors.affiliation: Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.|Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN.
authors.forename: Yader
authors.initials: Y
authors.lastname: Sandoval
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark kristhyg@rm.dk kthygesen@oncable.dk.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thygesen
mesh_terms: D015415:Biomarkers / Q000032:analysis; D006801:Humans; D009203:Myocardial Infarction / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy; D015427:Reperfusion Injury / Q000175:diagnosis* / Q000188:drug therapy; D014336:Troponin / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014336:Troponin