Two distinct clinical phenotypes of type 2 myocardial infarction were identified, with an overall major adverse cardiovascular event rate of 49.1% over a median 53-month follow-up.
Cohort (n=774)
Can distinct clinical phenotypes with different prognostic predictors be identified in patients with type 2 myocardial infarction?
Type 2 myocardial infarction can be classified into two distinct clinical phenotypes with different underlying etiologies, triggers, and prognostic predictors, highlighting the need for tailored management strategies.
Abstract Background Despite its high incidence and association with poor outcomes, diagnosing and managing type 2 myocardial infarction (T2MI) remains challenging, due to its heterogeneous presentations and the diverse clinical profiles that underlie it. Objective To identify key differences and distinct clinical phenotypes in a large T2MI population. Methods All consecutive NSTEMI patients undergoing coronary angiography (CAG) with a confirmed T2MI diagnosis between January 2017 and March 2023 were analyzed. Latent class analysis was employed to identify clinical phenotypes, and multivariable analyses were performed to determine prognostic predictors. A composite of major adverse cardiovascular events (MACE) was assessed during follow-up, along with additional outcomes. Results Among 774 T2MI patients, two phenotypes were identified. Phenotype 1 (P1 T2MI, 31.5%) was younger, with higher prevalence of non-atherosclerotic coronary causes and unknown etiologies. Phenotype 2 (P2 T2MI, 68.5%) exhibited greater comorbidity and higher atherosclerotic burden, and was more associated with triggers like sepsis, anemia, and respiratory failure. Over a median follow-up of 53 months MACE occurred in 49.1% of patients. Independent predictors of prognosis were peak troponin levels in P1 T2MI, and age, known CV disease, COPD, peak cardiac troponin levels, and Gensini score in P2 T2MI. Conclusions In T2MI, two different phenotypes can be found, each with peculiar clinical characteristics, precipitating factors, outcomes, and prognostic predictors. These findings highlight the potential of phenotyping to develop tailored diagnostic and therapeutic strategies for T2MI.
Basile et al. (2025) conducted a cohort in Type 2 myocardial infarction (T2MI) (n=774). Clinical phenotypes (Phenotype 1 vs Phenotype 2) was evaluated on Composite of major adverse cardiovascular events (MACE). Two distinct clinical phenotypes of type 2 myocardial infarction were identified, with an overall major adverse cardiovascular event rate of 49.1% over a median 53-month follow-up.