Key result
The current STEMI/NSTEMI paradigm misses at least 25% of acute coronary occlusions and over-triages a similar fraction, supporting a shift to an occlusion/nonocclusion MI (OMI/NOMI) paradigm.
Why the study?
The current STEMI/NSTEMI paradigm misses at least one-fourth of acute coronary occlusions and inappropriately over-triages patients to the catheterization laboratory.
Advocates for replacing the STEMI/NSTEMI paradigm with the OMI/NOMI paradigm to improve the accuracy of ECG-based triage for acute coronary occlusion.
Answers are grounded in this paper and cite their sources.
Challenges reliance on STEMI/NSTEMI for detecting occlusions; leaves open whether OMI/NOMI improves outcomes pending prospective trials.
It is increasingly evident that the ST-segment elevation (STE) myocardial infarction (MI)/non-STEMI paradigm that equates STEMI with acute coronary occlusion (ACO) is deceptive. This unfortunate paradigm, adhered to by the current guidelines, misses at least one-fourth of the ACOs, and unnecessarily over-triages a similar fraction of the patients to the catheterization laboratory. Accordingly, we have been calling for a new paradigm, the occlusion/nonocclusion MI (OMI/NOMI). Although this new OMI/NOMI paradigm is not limited to an electrocardiogram (ECG), the ECG will remain the cornerstone of this new paradigm because of its speed, repeatability, noninvasive nature, wide availability, and high diagnostic power for OMI. This review provides a step-by-step approach to ECG for the diagnosis of OMI.
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Aslanger et al. (2021) conducted a review in Myocardial infarction. Electrocardiogram (ECG) for occlusion myocardial infarction (OMI) vs. STEMI/NSTEMI paradigm was evaluated. The current STEMI/NSTEMI paradigm misses at least 25% of acute coronary occlusions and over-triages a similar fraction, supporting a shift to an occlusion/nonocclusion MI (OMI/NOMI) paradigm.
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