{"id":"fb1e4aecca24","type":"article","url":"https://hartvaat.nl/2026/01/06/biomarkers-onderscheiden-type-2-hartinfarct-nog-onvoldoende-van-type-1/","title":"Biomarkers onderscheiden type 2-hartinfarct nog onvoldoende van type 1","title_en":"Utility of biomarkers in patients with a type 2 myocardial infarction: a systematic review","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","diabetes-type-2","myocardinfarct","nt-probnp","troponine"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003867?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003867?rss=1","authors":["Gouda","P.","Lalani","S.","Newby","K.","Lopes","R.","Jones","S."],"significance":5,"published":"2026-01-06","source_date":"2026-01-06","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/","https://hartvaat.nl/kennis/coronairlijden/troponine-interpretatie/"],"congress":"","summary_en":"Distinguishing type 1 myocardial infarction (T1MI, from plaque rupture) from type 2 (T2MI, from supply-demand mismatch) is often difficult on clinical grounds. This systematic review examined whether biomarkers can help discriminate and prognosticate. Thirty-one studies (16,111 patients with T2MI) were included, of which 97% had moderate to high risk of bias. Traditional cardiac biomarkers (troponin, CK, BNP) discriminated T2MI from T1MI moderately (AUC 0.61-0.71); adding them to clinical variables improved this slightly (AUC 0.71-0.82). Non-traditional, metabolic and proteomic markers showed widely varying accuracy (AUC 0.50-0.77). Prognostic value was inconsistent. The role of biomarkers in diagnosing and prognosticating type 2 myocardial infarction thus remains unclear — better studies and a sharper definition of T2MI are needed.","created":"2026-07-03T10:32:28Z","updated":"2026-07-03T13:31:25Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Het onderscheid tussen een type 1-hartinfarct (T1MI, door plaqueruptuur) en een type 2-infarct (T2MI, door vraag-aanbodmismatch) is op klinische gronden vaak lastig. Deze systematische review onderzocht of biomarkers kunnen helpen onderscheiden en prognose geven. Er werden 31 studies (16.111 patiënten met T2MI) ingesloten, waarvan 97% een matig tot hoog risico op bias had. Traditionele cardiale biomarkers (troponine, CK, BNP) onderscheidden T2MI van T1MI matig (AUC 0,61-0,71); toevoeging aan klinische variabelen verbeterde dit licht (AUC 0,71-0,82). Niet-traditionele, metabole en proteomische markers toonden sterk wisselende nauwkeurigheid (AUC 0,50-0,77). De prognostische waarde was inconsistent. De rol van biomarkers bij de diagnose en prognose van het type 2-hartinfarct blijft dus onduidelijk — betere studies en een scherpere definitie van T2MI zijn nodig.","abstract_original":"Background\n

Differentiating type 1 myocardial infarctions (T1MI) from type 2 myocardial infarctions (T2MI) can be challenging based on clinical variables alone. This review aimed to explore the utility of novel and traditional biomarkers to discriminate between these entities and potentially provide additional prognostic information.

\n\nMethods\n

A systematic review of observational studies and randomised controlled trials that examined the discriminatory or prognostic roles of either traditional cardiac biomarkers (troponin, creatine kinase or b-type natriuretic peptide) or non-traditional biomarkers. Data sources included PubMed, SCOPUS, Web of Science, EMBASE and clinicaltrials.gov and were last searched on 15 November 2024. The diagnostic accuracy of biomarkers and prognostic utility of identified biomarkers are narratively reported.

\n\nResults\n

31 studies with 16 111 individuals with a T2MI were included. Most studies (97%) demonstrated moderate or severe risk of bias. Of studies that examined traditional cardiac biomarkers (n=13), the ability to discriminate between T2MI and T1MI ranged from an area under the curve (AUC) of 0.61–0.71. Studies that added traditional cardiac biomarkers to clinical variables (n=4) demonstrated a diagnostic accuracy AUC 0.71–0.82. Studies exploring non-traditional biomarkers, metabolic and proteomic profiles (n=14) demonstrated a wide range of diagnostic accuracy (AUC 0.50–0.77). Traditional cardiac biomarkers inconsistently demonstrated a correlation with subsequent cardiovascular events. The prognostic utility of non-traditional biomarkers was infrequently assessed.

\n\nConclusion\n

The role of biomarkers, metabolic and proteomic profiles in the diagnosis and prognostication of T2MI remains unclear. Higher quality studies and refining the classification of T2MI may improve this further.

\n\nPROSPERO registration number\n

CRD42023418095.

\n"}