Why the study?
The current STEMI/non-STEMI paradigm has important limitations, including missing acute coronary occlusions and causing unnecessary catheterization laboratory activations due to a poorly derived evidence base.
Comparison
Occlusion MI (OMI)/non-OMI paradigm vs STEMI/non-STEMI paradigm
Design
Review
This review challenges the current STEMI/NSTEMI guidelines, advocating for an OMI/NOMI paradigm to better identify patients needing emergency reperfusion.
The ST-elevation myocardial infarction (STEMI)/non-STEMI paradigm per the current guidelines has important limitations. It misses a substantial proportion of acute coronary occlusions (ACO) and results in a significant amount of unnecessary catheterization laboratory activations. It is not widely appreciated how poor is the evidence base for the STEMI criteria; the recommended STEMI cutoffs were not derived by comparing those with ACO with those without and not specifically designed for distinguishing patients who would benefit from emergency reperfusion. This review aimed to discuss the origins, evidence base, and limitations of STEMI/non-STEMI paradigm and to call for a new paradigm shift to the occlusion MI (OMI)/non-OMI.
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Aslanger et al. (2021) studied this question.
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