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ECG Patterns of Occlusion Myocardial Infarction : A Narrative Review

Ricci, Fabrizio LU ; Martini, Chiara ; Scordo, Davide Maria ; Rossi, Davide ; Gallina, Sabina ; Fedorowski, Artur LU orcid ; Sciarra, Luigi ; Chahal, C Anwar A ; Meyers, H Pendell and Herman, Robert , et al. (2025) In Annals of Emergency Medicine p.1-11
Abstract

The traditional management of acute coronary syndrome has relied on the identification of ST-segment elevation myocardial infarction (STEMI) as a proxy of acute coronary occlusion. This conflation of STEMI with acute coronary occlusion has historically overshadowed non-ST-segment elevation myocardial infarction (NSTEMI), despite evidence suggesting 25% to 34% of NSTEMI cases may also include acute coronary occlusion. Current limitations in the STEMI/NSTEMI binary framework underscore the need for a revised approach to chest pain and acute coronary syndrome management. The emerging paradigm distinguishing occlusion myocardial infarction from nonocclusion myocardial infarction (NOMI) seeks to enhance diagnostic accuracy and prognostic... (More)

The traditional management of acute coronary syndrome has relied on the identification of ST-segment elevation myocardial infarction (STEMI) as a proxy of acute coronary occlusion. This conflation of STEMI with acute coronary occlusion has historically overshadowed non-ST-segment elevation myocardial infarction (NSTEMI), despite evidence suggesting 25% to 34% of NSTEMI cases may also include acute coronary occlusion. Current limitations in the STEMI/NSTEMI binary framework underscore the need for a revised approach to chest pain and acute coronary syndrome management. The emerging paradigm distinguishing occlusion myocardial infarction from nonocclusion myocardial infarction (NOMI) seeks to enhance diagnostic accuracy and prognostic effect in acute coronary syndrome care. This approach not only emphasizes the urgency of reperfusion therapy for high-risk ECG patterns not covered by current STEMI criteria, but also emphasizes the broader transition from viewing acute coronary syndrome as a disease defined by the ECG to a disease defined by its underlying pathology, for which the ECG is an important but insufficient surrogate test. This report outlines the emerging occlusion myocardial infarction paradigm, detailing specific ECG patterns linked to acute coronary occlusion, and proposes a new framework that could enhance triage accuracy and treatment strategies for acute coronary syndrome. Although further validation is required, the occlusion myocardial infarction pathway holds promise for earlier acute coronary occlusion detection, timely cath lab activation, and improved myocardial salvage-offering potentially significant implications for both clinical practice and future research in acute coronary syndrome management.

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publishing date
type
Contribution to journal
publication status
epub
in
Annals of Emergency Medicine
pages
1 - 11
publisher
Elsevier
external identifiers
  • pmid:39818676
  • scopus:85215546503
ISSN
1097-6760
DOI
10.1016/j.annemergmed.2024.11.019
language
English
LU publication?
no
additional info
Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
id
1bde6132-021e-4076-9e92-aefed9055307
date added to LUP
2025-01-20 19:26:21
date last changed
2025-07-12 11:11:30
@article{1bde6132-021e-4076-9e92-aefed9055307,
  abstract     = {{<p>The traditional management of acute coronary syndrome has relied on the identification of ST-segment elevation myocardial infarction (STEMI) as a proxy of acute coronary occlusion. This conflation of STEMI with acute coronary occlusion has historically overshadowed non-ST-segment elevation myocardial infarction (NSTEMI), despite evidence suggesting 25% to 34% of NSTEMI cases may also include acute coronary occlusion. Current limitations in the STEMI/NSTEMI binary framework underscore the need for a revised approach to chest pain and acute coronary syndrome management. The emerging paradigm distinguishing occlusion myocardial infarction from nonocclusion myocardial infarction (NOMI) seeks to enhance diagnostic accuracy and prognostic effect in acute coronary syndrome care. This approach not only emphasizes the urgency of reperfusion therapy for high-risk ECG patterns not covered by current STEMI criteria, but also emphasizes the broader transition from viewing acute coronary syndrome as a disease defined by the ECG to a disease defined by its underlying pathology, for which the ECG is an important but insufficient surrogate test. This report outlines the emerging occlusion myocardial infarction paradigm, detailing specific ECG patterns linked to acute coronary occlusion, and proposes a new framework that could enhance triage accuracy and treatment strategies for acute coronary syndrome. Although further validation is required, the occlusion myocardial infarction pathway holds promise for earlier acute coronary occlusion detection, timely cath lab activation, and improved myocardial salvage-offering potentially significant implications for both clinical practice and future research in acute coronary syndrome management.</p>}},
  author       = {{Ricci, Fabrizio and Martini, Chiara and Scordo, Davide Maria and Rossi, Davide and Gallina, Sabina and Fedorowski, Artur and Sciarra, Luigi and Chahal, C Anwar A and Meyers, H Pendell and Herman, Robert and Smith, Stephen W}},
  issn         = {{1097-6760}},
  language     = {{eng}},
  month        = {{01}},
  pages        = {{1--11}},
  publisher    = {{Elsevier}},
  series       = {{Annals of Emergency Medicine}},
  title        = {{ECG Patterns of Occlusion Myocardial Infarction : A Narrative Review}},
  url          = {{http://dx.doi.org/10.1016/j.annemergmed.2024.11.019}},
  doi          = {{10.1016/j.annemergmed.2024.11.019}},
  year         = {{2025}},
}