Confusion remains
wide spread despite the publication of this distinction years ago.
But now, according to this piece in Circulation, the coding
world is finally catching up. ICD 10 now has a code for type 2 MI.
Here are some of my take home points:
A type 2 MI is not
an acute coronary syndrome.
On initial
presentation the distinction is based on clinical circumstances and
may occasionally be difficult.
Further
investigation usually makes the distinction clear by the end of the
hospitalization.
Type 2 MI, though a
distinct category, is not a primary single entity in that it is
always secondary to something else, one or more of many known
conditions. For this reason it is heterogeneous and there are no
guidelines for type 2 MI per se. Its treatment always consists of
management of the underlying conditions that are altering the
myocardial oxygen supply demand balance.
Though ICD 10 now
recognizes the distinction, type 2 MI has yet to be excluded from
certain performance and regulatory categories for MI due to acute
coronary syndrome.
Those who conflate
NSTEMI and type 2 MI not only expose their ignorance (or disregard)
of the classification and pathophysiology of MI but also risk
subjecting patients to inappropriate and potentially harmful
treatments. An example is provided in the article.
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