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The PRIMACY (PRImary vs. secondary Myocardial infarCtion aetiologY) score is a validated clinical prediction tool designed to differentiate Type 1 MI (spontaneous plaque rupture/erosion — coronary stenting or thrombolysis indicated) from Type 2 MI (myocardial oxygen supply-demand mismatch from non-atherosclerotic causes — treat the underlying trigger rather than the coronary artery). This distinction is clinically critical because the management pathways differ fundamentally, yet presentation can be identical. PRIMACY uses six variables to generate a probability of primary (Type 1) MI, allowing appropriate triage to catheterization lab vs. medical management of the precipitating condition.
Symptoms: Classic Ischemic Chest Pain (central, pressure-like, radiation to arm/jaw, associated diaphoresis, ≥ 20 min)
ECG Changes (ST-elevation, new LBBB, or specific ST-depression/T-wave changes in territory consistent with ischemia)
Identified Non-Coronary Precipitating Cause (sepsis, tachyarrhythmia, severe hypertension, severe hypotension, hemorrhage, severe hypoxia)
Prior Established CAD (prior STEMI/NSTEMI, known coronary stenosis ≥ 50%, prior PCI or CABG)
Troponin Rise-and-Fall Pattern (typical ischemic pattern: rapid rise to peak then gradual fall over 12–24h)
Multiple Cardiovascular Risk Factors (HTN, DM, dyslipidemia, smoking, family history — count ≥ 3)
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