{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:38:15Z","timestamp":1787503095832,"version":"build-2736575974"},"reference-count":81,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Type 2 myocardial infarction (T2MI) is defined as myocardial necrosis caused by an imbalance between oxygen supply and demand in the absence of acute atherothrombotic coronary occlusion\/erosion. Unlike type 1 myocardial infarction (T1MI), T2MI comprises a heterogeneous group of clinical scenarios, often triggered by systemic or cardiac conditions, and it frequently affects elderly patients with a high burden of comorbidities. T2MI often underline multivessel coronary artery disease and, despite its growing clinical relevance, the diagnostic and therapeutic approach to T2MI remains challenging and lacks standardized recommendations. In this review, we present an updated and a comprehensive synthesis of current evidence on the diagnosis and management of T2MI, focusing on the role of coronary angiography and interventional strategies. We discuss the utility of high-sensitivity cardiac biomarkers, imaging modalities, and clinical risk scores to guide patient selection for invasive evaluation. Specific attention is given to conservative and alternative revascularization approaches\u2014including drug-coated balloon angioplasty and stentless percutaneous coronary intervention (PCI)\u2014in frail and high-bleeding-risk patients. The review emphasizes the need for individualized decision-making in a population where standard invasive strategies may not always be appropriate, and where a tailored balance between ischemic and hemorrhagic risk is crucial.<\/jats:p>","DOI":"10.3390\/jcm15031279","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T15:24:19Z","timestamp":1770305059000},"page":"1279","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Type 2 Myocardial Infarction: Navigating Diagnostic Pathways and Therapeutic Crossroads Between Invasive and Conservative Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5159-3200","authenticated-orcid":false,"given":"Sebastian","family":"Cinconze","sequence":"first","affiliation":[{"name":"Division of Cardiology, Ospedale Civile di Vigevano, 27029 Vigevano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Bernelli","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Santa Corona Hospital, ASL2 Liguria, Via XXV Aprile 38, 17027 Pietra Ligure, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8333-672X","authenticated-orcid":false,"given":"Francesca","family":"Giordana","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ospedale Santa Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wang, Y., Li, Q., Bi, L., Wang, B., Lv, T., and Zhang, P. 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