New horizons in Type 2 myocardial infarction: pathogenesis, assessment and management of an emerging geriatric disease.
Fiche publication
Date publication
avril 2022
Journal
Age and ageing
Auteurs
Membres identifiés du Cancéropôle Est :
Pr COTTIN Yves
Tous les auteurs :
Putot A, Putot S, Chagué F, Cottin Y, Zeller M, Manckoundia P
Lien Pubmed
Résumé
Type 2 myocardial infarction (MI) is characterised by a functional imbalance between myocardial oxygen supply and demand in the absence of a thrombotic process, leading to myocardial necrosis. This type of MI was relatively unknown among clinicians until the third universal definition of MI was published in 2017, differentiating Type 2 from Type 1 MI, which follows an acute atherothrombotic event. The pathogenesis, diagnostic and therapeutic aspects of Type 2 MI are described in the present review. Type 2 MI is a condition that is strongly linked to age because of vascular ageing concerning both epicardic vessels and microcirculation, age-related atherosclerosis and stress maladaptation. This condition predominantly affects multimorbid individuals with a history of cardiovascular disease. However, the conditions that lead to the functional imbalance between oxygen supply and demand are frequently extra-cardiac (e.g. pneumonia or anaemia). The great heterogeneity of the underlying etiological factors requires a comprehensive approach that is tailored to each case. In the absence of evidence for the benefit of invasive reperfusion strategies, the treatment of Type 2 MI remains to date essentially based on the restoration of the balance between oxygen supply and demand. For older co-morbid patients with Type 2 MI, geriatricians and cardiologists need to work together to optimise etiological investigations, treatment and prevention of predisposing conditions and precipitating factors.
Mots clés
acute coronary syndrome, aged, atherosclerosis, myocardial injury, older people, respiratory infection
Référence
Age Ageing. 2022 Apr 1;51(4):