Friday, June 20, 2014

Type 2 MI: addressing and resolving the confusion

A review article addressing this topic is available as free full text from the American Journal of Medicine.

The classification of MI into types 1-5 is linked here.

Confusion may exist between type 2 MI and elevated troponin due to non ischemic myocardial necrosis occurring in a variety of severe illnesses. Perhaps the most familiar example of the latter condition is the troponin elevation that accompanies sepsis. Though long recognized and purported to be due to a variety of mechanisms it remains poorly understood.

Troponin measurements in a variety of critical illnesses may be useful for prognostic stratification but elevated values do not always point to the need for coronary intervention, and must be correlated with other clinical findings.

The patient with type 2 MI may or may not have atherosclerotic coronary artery disease. Clinical judgment should determine whether the patient needs evaluation for CAD and the timing of such evaluation.

1 comment:

Williams said...

Though a nice classification clinically, when it comes to coding it codes out just like any MI would. Hence the metrics such as LOS, Mortality and even the core measures may fall out or fail secondary to calling an elevated troponin in face of sepsis a Type 2 mi. See this everyday in our facility. I would caution against using the classification and consider describing exactly what it is....elevated troponin secondary to sepsis/copd and hypoxia etc.