心肌梗死与心肌挫伤之间的治疗转化：机遇、边界和双向启示

本综述探讨心肌挫伤（MC）与心肌梗死（MI）之间不对称的治疗关系。尽管这两种心肌损伤形式源于不同的起始事件，但它们在关键的继发性损伤通路方面存在交汇，包括炎症激活、氧化应激、钙稳态失调、细胞死亡、纤维化和心室重构。其目的在于阐明心肌梗死中的哪些要素可为心肌挫伤提供具有生物学可转化性的假设，哪些要素在临床上不可转化，以及创伤如何揭示经典心肌梗死治疗的情境性边界。证据主要检索自PubMed和CNKI，涵盖2000年1月至2026年1月期间发表的文献，包括实验研究、临床研究、影像学研究以及指南或共识文件。比较文献表明，心肌挫伤与心肌梗死之间的主要差异并不在于是否存在心肌损伤本身，而在于原发损伤因素、组织损伤的空间组织方式、诊断解释逻辑以及治疗决策顺序。在这一背景下，心肌梗死不应被视为可直接转用于心肌挫伤的治疗模板，而应被视为一种更成熟的、基于机制的假设来源，尤其适用于炎症放大、氧化损伤、不良重构、心律风险监测以及生物标志物-影像整合等方面的调控。相反，心肌挫伤在临床上的意义，与其说是心肌梗死的治疗类似物，不如说是一种边界条件，可阐明心肌损伤管理对病因、出血风险、结构性损伤以及相互竞争的临床优先事项的依赖性。未来研究应优先关注创伤特异性表型分析、多模态诊断分层、生物标志物-影像整合，以及在不延误病情稳定处理的前提下，对与创伤治疗相兼容的辅助靶向干预进行前瞻性评价。

1. Nair L, Winkle B, Senanayake E. Managing blunt cardiac injury. J Cardiothorac Surg. 2023;18(1):71. doi: 10.1186/s13019-023-02146-z

2. Gürmen ES, Tulay CM. Attention: cardiac contusion. Turk J Trauma Emerg Surg. 2022;28(5):634–640. doi: 10.14744/tjtes.2021.11290

3. Lee C, Jebbia M, Morchi R, Grigorian A, Nahmias J. Cardiac trauma: a review of penetrating and blunt cardiac injuries. Am Surg. 2025;91(3):423-433. doi: 10.1177/00031348241307400

4. Pooler C, Barkman A. Myocardial injury: contrasting infarction and contusion. Crit Care Nurse. 2002;22(1):15–26. doi: 10.4037/ccn2002.22.1.15

5. Li Z, Wereski R, Anand A, et al. Uniform or sex-specific cardiac troponin thresholds to rule out myocardial infarction at presentation. J Am Coll Cardiol. 2024;83(19):1855– 1866. doi: 10.1016/j.jacc.2024.03.365

6. Shoar S, Hosseini FS, Naderan M, et al. Cardiac injury following blunt chest trauma: diagnosis, management, and uncertainty. Int J Burns Trauma. 2021;11(2):80–89. Accessed May, 14 2026. https://pmc.ncbi.nlm.nih.gov/articles/PMC8166660/

7. Hausenloy DJ, Yellon DM. Myocardial ischemia-reperfusion injury: a neglected therapeutic target. J Clin Invest. 2013;123(1):92–100. doi: 10.1172/JCI62874

8. Welt FGP, Batchelor W, Spears JR, et al. Reperfusion injury in patients with acute myocardial infarction. J Am Coll Cardiol. 2024;83(22):2196–2213. doi: 10.1016/j.jacc.2024.02.056

9. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826. doi: 10.1093/eurheartj/ehad191

10. Alborzi Z, Zangouri V, Paydar S, et al. Diagnosing myocardial contusion after blunt chest trauma. J Tehran Heart Cent. 2016;11(2):49-54.

11. Rao SV, O’Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2025;151(13). doi: 10.1161/CIR.0000000000001309

12. Lindahl B, Mills NL. A new clinical classification of acute myocardial infarction. Nat Med. 2023;29(9):2200–2205. doi: 10.1038/s41591-023-02513-2

13. DeFilippis AP, Blaha MJ. Defining myocardial infarction: grades of severity or different aetiology. Eur Heart J Acute Cardiovasc Care. 2025;14(3):142–144. doi: 10.1093/ehjacc/zuaf025

14. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237–269. doi: 10.1093/eurheartj/ehy462

15. Huis In ‘T Veld MA, Craft CA, Hood RE. Blunt Cardiac Trauma Review. Cardiol Clin. 2018;36(1):183–191. doi: 10.1016/j.ccl.2017.08.010

16. Patel KM, Kumar NS, Desai RG, Mitrev L, Trivedi K, Krishnan S. Blunt trauma to the heart: a review of pathophysiology and current management. J Cardiothorac Vasc Anesth. 2022;36(8):2707–2718. doi: 10.1053/j.jvca.2021.10.018

17. EL-Andari R, O’Brien D, Bozso SJ, Nagendran J. Blunt cardiac trauma: a narrative review. Mediastinum. 2021;5:28–28. doi: 10.21037/med-21-19

18. Hammer MM, Raptis DA, Cummings KW, et al. Imaging in blunt cardiac injury: computed tomographic findings in cardiac contusion and associated injuries. Injury. 2016;47(5):1025–1030. doi: 10.1016/j.injury.2015.11.008

19. Musher DM, Abers MS, Corrales-Medina VF. Acute infection and myocardial infarction. N Engl J Med. 2019;380(2):171–176. doi: 10.1056/NEJMra1808137

20. Chapman AR, Taggart C, Boeddinghaus J, Mills NL, Fox KAA. Type 2 myocardial infarction: challenges in diagnosis and treatment. Eur Heart J. 2025;46(6):504–517. doi: 10.1093/eurheartj/ehae803

21. Palermi A, Saraullo S, Giordano MB, Ricci F, Gallina S, Renda G. Revisiting type 2 myocardial infarction: unmet clinical needs. Curr Probl Cardiol. 2025;50(10):103148. doi: 10.1016/j.cpcardiol.2025.103148

22. Heusch G. Myocardial stunning and hibernation revisited. Nat Rev Cardiol. 2021;18(7):522–536. doi: 10.1038/s41569-021-00506-7

23. Zolotov AN, Klyuchnikova EI, Korpacheva OV, Priymak AB. Сократительная функция миокарда в посттравматическом периоде ушиба сердца у крыс с различной стрессоустойчивостью: доклиническое экспериментальное рандомизированное исследование. Kuban Sci Med Bull. 2024;31(5):41–72. doi: 10.25207/1608-6228-2024-31-5-41-72

24. Weber B, Lackner I, Gebhard F, Miclau T, Kalbitz M. Trauma, a matter of the heart—molecular mechanism of post-traumatic cardiac dysfunction. Int J Mol Sci. 2021;22(2):737. doi: 10.3390/ijms22020737

25. Rocksén D, Gryth D, Druid H, Gustavsson J, Arborelius UP. Pathophysiological effects and changes in potassium, ionised calcium, glucose and haemoglobin early after severe blunt chest trauma. Injury. 2012;43(5):632–637. doi: 10.1016/j.injury.2010.10.002

26. Daseke MJ, Tenkorang MAA, Chalise U, Konfrst SR, Lindsey ML. Cardiac fibroblast activation during myocardial infarction wound healing. Matrix Biol. 2020;91–92:109– 116. doi: 10.1016/j.matbio.2020.03.010

27. Weinberger T, Schulz C. Myocardial infarction: a critical role of macrophages in cardiac remodeling. Front Physiol. 2015;6:107. doi: 10.3389/fphys.2015.00107

28. Giraud MN. Macrophage leukotriene B4 production sustains inflammation after myocardial infarction. Eur Heart J. 2026;47(4):519–521. doi: 10.1093/eurheartj/ehaf471

29. Priymak AB, Korpacheva OV, Zolotov AN, Kluchnikova EI. Роль агониста периферических опиатных рецепторов в патогенезе ушиба сердца у крыс с различной стрессустойчивостью. Fundam Clin Med. 2022;7(2):8–19. doi: 10.23946/2500-0764-2022-7-2-8-19

30. Klyuchnikova EI, Korpacheva OV, Mozgovoi SI, Zolotov AN, Kononov AV. Экспрессия Beclin-1 и Caspase 3 в посттравматическом периоде экспериментального ушиба сердца у крыс с различной стрессоустойчивостью. Fundam Clin Med. 2024;9(2):8–19. doi: 10.23946/2500-0764-2024-9-2-8-19

31. Klyuchnikova EI, Mozgovoy SI, Zolotov AN, Korpacheva OV, Kononov AV. Экспрессия Beclin-1 и Caspase 3 в посттравматическом периоде экспериментального ушиба сердца у крыс с различной стрессоустойчивостью. Mod Probl Sci Educ. 2025;(1):36. doi: 10.17513/spno.33940

32. Agyapong ED, Pedriali G, Ramaccini D, et al. Calcium signaling from sarcoplasmic reticulum and mitochondria contact sites in acute myocardial infarction. J Transl Med. 2024;22(1):552. doi: 10.1186/s12967-024-05240-5

33. Räber L, Ueki Y, Otsuka T, et al. Effect of alirocumab added to high-intensity statin therapy on coronary atherosclerosis in patients with acute myocardial infarction: the PACMAN-AMI randomized clinical trial. JAMA. 2022;327(18):1771. doi: 10.1001/jama.2022.5218

34. Bıçakçı N, Karaboğa İ, Dökmeci AH, Güzel S, Fidanol Erboğa Z. Cardioprotective effect of caffeic acid phenethyl ester on cardiac contusion following blunt chest trauma in rats. Biotech Histochem. 2019;94(6):442–448. doi: 10.1080/10520295.2019.1586999

35. Zolotov AN, Li J, Wang N, et al. Treatment of cardiac contusion: experimental basis for pathogenetic therapy and emerging approaches in cardioprotection. Eurasian J Life Sci. 2025;1(1):53–72. doi: 10.47093/3033-5493.2025.1.1.53-72

36. Elikowski W, Szczęśniewski P, Fertała N, Zawodna-Marszałek M, Baszko A, Żytkiewicz M. Fast resolution of mild midvetricular takotsubo syndrome triggered by blunt chest trauma: case study. Pol Merkuriusz Lek. 2024;52(3):368–372. doi: 10.36740/Merkur202403115

37. Lyon AR, Citro R, Schneider B, et al. Pathophysiology of takotsubo syndrome. J Am Coll Cardiol. 2021;77(7):902–921. doi: 10.1016/j.jacc.2020.10.060

38. Frederiksen TC, Dahm CC, Preis SR, et al. The bidirectional association between atrial fibrillation and myocardial infarction. Nat Rev Cardiol. 2023;20(9):631–644. doi: 10.1038/s41569-023-00857-3

39. Lv B, Zhou J, He S, et al. Induction of myocardial infarction and myocardial ischemiareperfusion injury in mice. J Vis Exp. 2022;(179):63257. doi: 10.3791/63257

40. Kitsis RN. Regulated cell death in myocardial infarction. Circ Res. 2025;137(6):924– 929. doi: 10.1161/CIRCRESAHA.125.323052

41. Piamsiri C, Maneechote C, Jinawong K, et al. Pharmacological inhibition of apoptosis, necroptosis, and ferroptosis confers effective cardioprotection in post-myocardial infarction in rats. Sci Rep. 2025;15(1):31140. doi: 10.1038/s41598-025-17275-9

42. Wang J, Yang Bennett DS, Echard EJ, et al. Junctophilin-2 regulates store-operated calcium entry to drive cardiac fibroblast activation, fibrotic repair, and angiogenesis after myocardial infarction. Circulation. 2025;152(10):699–716. doi: 10.1161/CIRCULATIONAHA.125.073937

43. Vago H, Toth A, Apor A, Maurovich-Horvat P, Toth M, Merkely B. Cardiac contusion in a professional soccer player: visualization of acute and late pathological changes in the myocardium with magnetic resonance imaging. Circulation. 2010;121(22):2456– 2461. doi: 10.1161/CIRCULATIONAHA.109.917724

44. Caprettini V. An antifibrotic therapy for myocardial infarction. Nat Biomed Eng. 2024;8(12):1509–1509. doi: 10.1038/s41551-024-01335-y

45. Bernardis V, Kette F, Blarasin L, Pegoraro C, Coassin R. Isolated myocardial contusion in blunt chest trauma: Eur J Emerg Med. 2004;11(5):287–290. doi: 10.1097/00063110-200410000-00010

46. Tenzer ML. The spectrum of myocardial contusion: a review. J Trauma Inj Infect Crit Care. 1985;25(7):620–627. doi: 10.1097/00005373-198507000-00008

47. Chanakhchian FN, Alekhnovich AV, Vakhromeeva MN, Denisenko-Kankiya EI, Akhiev MI, Rumyantseva AM. Современные представления о травме сердца. [Cardiac trauma: state-of-art review] (In Russian). Bull Pirogov Natl Med Surg Cent. 2024;19(4):93–100. doi: 10.25881/20728255_2024_19_4_93

48. Koshlyak DA, Savchenko SV, Novoselov VP. Экспертное наблюдение смертельного ушиба сердца при падении с высоты. Bulletin of Forensic Medicine. 2019;8(2):70–73. Accessed May, 14 2026. https://www.elibrary.ru/item.asp?id=39135817

49. Amichi A. Quantitative texture analysis and transesophageal echocardiography to characterize the acute myocardial contusion. Open Med Inform J. 2009;3(1):13–18. doi: 10.2174/1874431100903010013

50. Van Lieshout EMM, Verhofstad MHJ, Van Silfhout DJT, Dubois EA. Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature. Eur J Trauma Emerg Surg. 2021;47(4):1259–1272. doi: 10.1007/s00068-020-01305-4

51. Wu Y, Qamar SR, Murray N, Nicolaou S. Imaging of cardiac trauma. Radiol Clin North Am. 2019;57(4):795–808. doi: 10.1016/j.rcl.2019.02.006

52. Burrell AJ, Kaye DM, Fitzgerald MC, et al. Cardiac magnetic resonance imaging in suspected blunt cardiac injury: A prospective, pilot, cohort study. Injury. 2017;48(5):1013–1019. doi: 10.1016/j.injury.2017.02.025

53. Chebrolu L, McKay J, Parker J, Kurrelmeyer K. Complications of cardiac contusion diagnosed using multimodality imaging. Methodist DeBakey Cardiovasc J. 2015;11(4):253. doi: 10.14797/mdcj-11-4-253

54. Neumann JT, Twerenbold R, Ojeda F, et al. Application of high-sensitivity troponin in suspected myocardial infarction. N Engl J Med. 2019;380(26):2529–2540. doi: 10.1056/NEJMoa1803377

55. Wereski R, Kimenai DM, Taggart C, et al. Cardiac troponin thresholds and kinetics to differentiate myocardial injury and myocardial infarction. Circulation. 2021;144(7):528–538. doi: 10.1161/CIRCULATIONAHA.121.054302

56. Boeddinghaus J, Li Z, Bularga A, et al. Clinical decisions and outcomes after switching high-sensitivity cardiac troponin assays in suspected ACS: an interrupted time-series study. JAMA Cardiol. 2026;11(2):186. doi: 10.1001/jamacardio.2025.4661

57. Barker S, Ghaemmaghami C. Myocardial contusion–induced right bundle-branch block with ST elevation and troponin elevation. Am J Emerg Med. 2009;27(3):375. e5–375.e7. doi: 10.1016/j.ajem.2008.08.006

58. Okubo N, Hombrouck C, Fornes P, et al. Cardiac troponin I and myocardial contusion in the rabbit. Anesthesiology. 2000;93(3):811–817. doi: 10.1097/00000542-200009000-00031

59. Edouard AR, Felten ML, Hebert JL, Cosson C, Martin L, Benhamou D. Incidence and significance of cardiac troponin I release in severe trauma patients. Anesthesiology. 2004;101(6):1262–1268. doi: 10.1097/00000542-200412000-00004

60. Joseph B, Jokar TO, Khalil M, et al. Identifying the broken heart: predictors of mortality and morbidity in suspected blunt cardiac injury. Am J Surg. 2016;211(6):982–988. doi: 10.1016/j.amjsurg.2015.10.027

61. Grigorian A, Milliken J, Livingston JK, et al. National risk factors for blunt cardiac injury: hemopneumothorax is the strongest predictor. Am J Surg. 2019;217(4):639– 642. doi: 10.1016/j.amjsurg.2018.07.043

62. DeFilippis AP, Chapman AR, Mills NL, et al. Assessment and treatment of patients with type 2 myocardial infarction and acute nonischemic myocardial injury. Circulation. 2019;140(20):1661–1678. doi: 10.1161/CIRCULATIONAHA.119.040631

63. Sandoval Y, Jaffe AS. Type 2 myocardial infarction. J Am Coll Cardiol. 2019;73(14):1846– 1860. doi: 10.1016/j.jacc.2019.02.018

64. Stojanovska J, Hurwitz Koweek LM, Chung JH, et al. ACR Appropriateness criteria blunt chest trauma-suspected cardiac injury. J Am Coll Radiol. 2020;17(11):S380– S390. doi: 10.1016/j.jacr.2020.09.012

65. Kyriazidis IP, Jakob DA, Vargas JAH, et al. Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis. World J Emerg Surg. 2023;18(1):36. doi: 10.1186/s13017-023-00504-9

66. Sade R, Kantarci M, Ogul H, et al. The feasibility of dual-energy computed tomography in cardiac contusion imaging for mildest blunt cardiac injury. J Comput Assist Tomogr. 2017;41(3):354–359. doi: 10.1097/RCT.0000000000000545

67. Biffl WL, Fawley JA, Mohan RC. Diagnosis and management of blunt cardiac injury: What you need to know. J Trauma Acute Care Surg. 2024;96(5):685–693. doi: 10.1097/TA.0000000000004216

68. Khang TT. Management of cardiac trauma and penetrating cardiac injuries with severe hemorrhagic shock: a 5-year experience. J Trauma Inj. 2024;37(4):268–275. doi: 10.20408/jti.2024.0063

69. Taggart C, Wereski R, Mills NL, Chapman AR. Diagnosis, Investigation and Management of Patients with Acute and Chronic Myocardial Injury. J Clin Med. 2021;10(11):2331. doi: 10.3390/jcm10112331

70. Biondi NL, Bhandari M, Bhyan P. Transient right bundle branch block resulting from a blunt cardiac injury during a motor vehicle accident. Cureus. 2020;12(9):e10534. doi: 10.7759/cureus.10534

71. Morsy M, Efeovbokhan N, Jha SK. Complete heart block and asystole following blunt cardiac trauma. J Community Hosp Intern Med Perspect. 2015;5(5):28423. doi: 10.3402/jchimp.v5.28423

72. Jung LY, Rhee KS. Delayed complete heart block in blunt cardiac injury (myocardial contusion). Eur Heart J — Cardiovasc Imaging. 2023;24(8):e203–e203. doi: 10.1093/ehjci/jead105

73. Chae R, D’Ambrosio N, Kulshrestha K, et al. Cardiac arrhythmias in trauma patients undergoing pericardiotomy: a retrospective analysis. J Surg Res. 2024;303:554– 560. doi: 10.1016/j.jss.2024.09.070

74. Korpacheva OV, Dolgikh VT. Электрокардиографические нарушения при ушибе сердца (экспериментальное исследование). Gen Reanimatol. 2006;2(6):29. doi: 10.15360/1813-9779-2006-6-29-34

75. Bartoszcze A, J. Rams D, Filip G, Bartuś K, Kapelak B, Litwinowicz R. Diagnostic problems and emergency cardiac surgeryin cut-like penetrating cardiac trauma. Pol J Cardio-Thorac Surg. 2021;18(3):192–194. doi: 10.5114/kitp.2021.109367

76. Dogan H, Sarikaya S, Neijmann ST, et al. N-terminal pro-B-type natriuretic peptide as a marker of blunt cardiac contusion in trauma. Int J Clin Exp Pathol. 2015;8(6):6786– 6792.

77. Jering KS, Claggett BL, Pfeffer MA, et al. Prognostic importance of NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) following high-risk myocardial infarction in the PARADISE-MI Trial. Circ Heart Fail. 2023;16(5). doi: 10.1161/CIRCHEARTFAILURE.122.010259

78. Haller PM, Kellner C, Sörensen NA, et al. Long-term outcome of patients presenting with myocardial injury or myocardial infarction. Clin Res Cardiol. 2025;114(6):700– 708. doi: 10.1007/s00392-023-02334-w

79. Silvain J, Cayla G, Ferrari E, et al. Beta-blocker interruption or continuation after myocardial infarction. N Engl J Med. 2024;391(14):1277–1286. doi: 10.1056/NEJMoa2404204

80. Huber CA, Meyer MR, Steffel J, Blozik E, Reich O, Rosemann T. Post-myocardial infarction (MI) care: medication adherence for secondary prevention after MI in a large real-world population. Clin Ther. 2019;41(1):107–117. doi: 10.1016/j.clinthera.2018.11.012

81. Samsky MD, Morrow DA, Proudfoot AG, Hochman JS, Thiele H, Rao SV. Cardiogenic shock after acute myocardial infarction: a review. JAMA. 2021;326(18):1840. doi: 10.1001/jama.2021.18323

82. Lu L, Liu M, Sun R, Zheng Y, Zhang P. Myocardial infarction: symptoms and treatments. Cell Biochem Biophys. 2015;72(3):865–867. doi: 10.1007/s12013-015-0553-4

83. Gong FF, Vaitenas I, Malaisrie SC, Maganti K. Mechanical complications of acute myocardial infarction: a review. JAMA Cardiol. 2021;6(3):341. doi: 10.1001/jamacardio.2020.3690

84. Bellister SA, Dennis BM, Guillamondegui OD. Blunt and penetrating cardiac trauma. Surg Clin North Am. 2017;97(5):1065–1076. doi: 10.1016/j.suc.2017.06.012

85. Mistry RN, Moore JE. Management of blunt thoracic trauma. BJA Educ. 2022;22(11):432–439. doi: 10.1016/j.bjae.2022.08.002

86. Marcolini EG, Keegan J. Blunt cardiac injury. Emerg Med Clin North Am. 2015;33(3):519–527. doi: 10.1016/j.emc.2015.04.003

87. Kutcher ME, Forsythe RM, Tisherman SA. Emergency preservation and resuscitation for cardiac arrest from trauma. Int J Surg. 2016;33:209–212. doi: 10.1016/j.ijsu.2015.10.014

88. Niemann M, Graef F, Hahn F, et al. Emergency thoracotomies in traumatic cardiac arrests following blunt trauma — experiences from a German level I trauma center. Eur J Trauma Emerg Surg. 2023;49(5):2177–2185. doi: 10.1007/s00068-023-02289-7

89. Talving P, Demetriades D. Cardiac trauma during teenage years. Pediatr Clin North Am. 2014;61(1):111–130. doi: 10.1016/j.pcl.2013.09.016

90. An Z, Tian J, Liu Y, et al. Exosomes as a cell-free therapy for myocardial injury following acute myocardial infarction or ischemic reperfusion. Aging Dis. 2022;13(6):1770. doi: 10.14336/AD.2022.0416

91. Bahr FS, Ricke-Hoch M, Ponimaskin E, Müller FE. Serotonin receptors in myocardial infarction: friend or foe? ACS Chem Neurosci. 2024;15(8):1619–1634. doi: 10.1021/acschemneuro.4c00031

92. Carroll MB, Haller C, Smith C. Short-term application of tocilizumab during myocardial infarction (STAT-MI). Rheumatol Int. 2018;38(1):59–66. doi: 10.1007/s00296-017-3842-y

93. Wang N, Huang J, Fang Y, Du H, Chen Y, Zhao S. Molecular biomarkers of blunt cardiac injury: recent advances and future perspectives. Expert Rev Mol Diagn. 2024;24(11):1023–1031. doi: 10.1080/14737159.2024.2405919