Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome

Q: What are the key findings of this study?

NSTEMI-OMI was present in 31.3% of type I NSTEMI patients and was associated with similar 5-year all-cause mortality compared to NSTEMI-NOMI (adjHR 1.13), likely due to earlier invasive management.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Type I Non-ST-segment elevation myocardial infarction (NSTEMI) (n=801). Intervention: Occlusion myocardial infarction (NSTEMI-OMI) vs. Non-occlusion myocardial infarction (NSTEMI-NOMI). Primary outcome: 5-year all-cause mortality (adjHR 1.13, 95% CI 0.78-1.63, p=0.51).

Q: What does this research mean for the field?

NSTEMI due to a completely occluded culprit artery (NSTEMI-OMI) is associated with similar 5-year mortality compared to other type I NSTEMI, despite presenting with higher-risk clinical features. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lea Kirsten; Pedro Lopez-Ayala; Emel Kaplan; Jasper Boeddinghaus; Luca Koechlin; Lourdes Herraiz-Recuenco; Gabrielle Huré; K Wildi; Paolo Bima; Jonas Glaeser; Carlos C. Spagnuolo; Luca Crisanti; Ò Miró; Michael Christ; Dagmar I. Keller; F J Martin-Sanchez; Roland Bingisser; Gregor Leibundgut; Felix Mahfoud; Ivo Strebel; Christian Mueller; the APACE investigators; Desiree Wussler; Thomas Nestelberger; Maria Rubini Gimenez; Juliane Gehrke; Jude Formambuh; Tobias Zimmermann; Christian Puelacher; Ksenija Slankamena; Gualandro Dm; Andreas Buser; Eliška Potluková; Damian Kawecki; Nicolas Geigy; Katharina Rentsch; Beata Morawiec; Piotr Munzk; Beatriz López; Gemma Martinez-Nadal; Carolina Fuenzalida; Sofía Calderón; Esther Rodriguez Adrada; Eva Ganovská; Jiri Parenica; Arnold von Eckardstein; Isabel Campodarve; Joachim Gea; Christian Nickel

doi:10.1007/s00392-026-02966-8

July 22, 2026Clinical Research in CardiologyOpen Access

Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome

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Key result

NSTEMI-OMI shows similar 5-year mortality to NSTEMI-NOMI despite higher risk, likely reflecting earlier revascularization.

adjHR 1.13
95% CI 0.78-1.63
P=0.51
n=801

Figures

Why the study?

Does occlusion myocardial infarction (NSTEMI-OMI) increase 5-year mortality compared to non-occlusion myocardial infarction in patients with type I NSTEMI?

Key Points

To evaluate the prevalence, clinical characteristics, invasive management, and 5-year mortality of occlusion myocardial infarction in patients presenting with type I NSTEMI.
Analyzed 801 consecutive patients with centrally adjudicated type I NSTEMI from an international multicenter study.
Classified patients as NSTEMI-OMI if they exhibited coronary TIMI flow grade 0 or 1, or grade 2 with > 70% narrowing and high-sensitivity cardiac troponin T (hs-cTnT) ≥ 500 ng/L, comparing them to non-occlusive NSTEMI (NSTEMI-NOMI) over 5 years of follow-up.
A total of 251 patients (31.3%) presented with NSTEMI-OMI, experiencing more frequent persistent chest pain (56.1% vs. 37.9%, p < 0.001) and ST-segment depression (34.3% vs. 23.0%, p < 0.001) than NSTEMI-NOMI.
Patients with NSTEMI-OMI underwent significantly faster coronary angiography (median 7.2 h [IQR 4.7, 21.8] vs. 19.6 h [IQR 6.2, 27.9], p < 0.001) and coronary revascularisation (median 8.2 h [IQR 4.9, 24.0] vs. 22.0 h [IQR 6.3, 46.1], p < 0.001).
Five-year all-cause mortality was comparable between NSTEMI-OMI and NSTEMI-NOMI (adjHR 1.13 [95% CI 0.78-1.63], p = 0.51), with overall cohort mortality reaching 17.9%.

Study Design

Type

Observational (n=801)

Multicenter

Yes

Structured PICO

Does occlusion myocardial infarction (NSTEMI-OMI) increase 5-year mortality compared to non-occlusion myocardial infarction in patients with type I NSTEMI?

P

Population

801 adult patients with centrally adjudicated type I NSTEMI who underwent coronary angiography, followed for 5 years to assess long-term outcomes.

E

Exposure

NSTEMI-OMI (occlusion myocardial infarction), defined as TIMI flow grade 0-1 or grade 2 with severe coronary narrowing (>70%) and peak hs-cTnT ≥ 500 ng/L

C

Comparator

NSTEMI-NOMI (non-occlusion myocardial infarction, other type I NSTEMI)

O

Outcome

5-year all-cause mortalityhard clinical

Main Result

Hazard Ratio: 1.13 (95% CI 0.78–1.63)

p-value: p=0.51

Limitations

Limited power to detect mortality differences across subgroups
Observational design does not allow to prove causality
Unmeasured confounding variables may have influenced findings
No universally accepted definition of OMI
Potential risk of misclassification due to subjective hs-cTn thresholds and angiographic findings
Information regarding the timing of echocardiography and pharmacological treatments was unavailable for most patients
Findings only apply to an invasively managed, angiographically available type I NSTEMI subset

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

May support expedited angiography for higher-risk NSTEMI-OMI presentations; leaves open whether routine OMI identification improves outcomes in RCTs.

Abstract

BACKGROUND: The prevalence, characteristics, management, and long-term outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI) due to a completely occluded culprit coronary artery (NSTEMI-OMI) remain insufficiently characterised. METHODS: In this international multicentre study, consecutive patients with centrally adjudicated type I NSTEMI were classified as NSTEMI-OMI if they had a TIMI flow grade of 0 or 1 or grade 2 with severe coronary narrowing (> 70%) and a high-sensitivity cardiac troponin T (hs-cTnT) ≥ 500 ng/L. Prospectively recorded chest pain characteristics, 12-lead ECG, serial hs-cTnT concentrations, time to coronary angiography/revascularisation, and 5-year mortality were compared in patients with NSTEMI-OMI versus other type I NSTEMI (NSTEMI-NOMI). RESULTS: Among 801 patients with type I NSTEMI (median age 68 years, 22.2% female), 251 patients (31.3%) had NSTEMI-OMI. Patients with NSTEMI-OMI presented more often with persistent chest pain (56.1% vs. 37.9%, p < 0.001), more often had ST-segment depression (34.3% vs. 23.0%, p < 0.001), and exhibited higher and faster rising hs-cTnT concentrations. Time from admission to coronary angiography (median 7.2 h [IQR 4.7, 21.8] vs. 19.6 h [IQR 6.2, 27.9], p < 0.001) and coronary revascularisation (median 8.2 h [IQR 4.9, 24.0] vs. 22.0 h [IQR 6.3, 46.1], p < 0.001) were both significantly shorter in patients with NSTEMI-OMI versus NSTEMI-NOMI. Five-year mortality was comparable in patients with NSTEMI-OMI versus NSTEMI-NOMI (adjHR 1.13 [95% CI 0.78-1.63], p = 0.51). CONCLUSION: One in three patients with type I NSTEMI had NSTEMI-OMI. These patients more often present with very high-risk clinical, ECG, and biomarker features and receive earlier invasive management. Likely related to the latter, 5-year mortality was similar between NSTEMI-OMI and NSTEMI-NOMI.

Discussion

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Cite This Study

Kirsten et al. (2026) conducted an observational in Type I Non-ST-segment elevation myocardial infarction (NSTEMI) (n=801). Occlusion myocardial infarction (NSTEMI-OMI) vs. Non-occlusion myocardial infarction (NSTEMI-NOMI) was evaluated on 5-year all-cause mortality (adjHR 1.13, 95% CI 0.78-1.63, p=0.51). NSTEMI-OMI was present in 31.3% of type I NSTEMI patients and was associated with similar 5-year all-cause mortality compared to NSTEMI-NOMI (adjHR 1.13), likely due to earlier invasive management.

synapsesocial.com/papers/6a62ac7bd5329adc8402ba94 https://doi.org/10.1007/s00392-026-02966-8

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Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Occlusion myocardial infarction in type I NSTEMI: prevalence, characteristics, management, and long-term outcome

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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