Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction

Meyers, H. Pendell; Bracey, Alexander; Lee, Daniel; Lichtenheld, Andrew; Li, Wei J.; Singer, Daniel; Rollins, Zach; Kane, Jesse; Dodd, Kenneth W.; Meyers, Kristen; Shroff, Gautam R.; Singer, Adam J.; Smith, Stephen W.

doi:10.1016/j.ijcha.2021.100767

Cited by 35 publications

(39 citation statements)

References 55 publications

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“…Aslanger et al reported that we needed to recognize subtle ECG changes in treating in the patients with acute coronary syndrome [ 6 - 9 ]. Therefore, Pendell Meyers et al reported that other diagnostic tools need to be determined to compensate for STEMI criteria [ 10 ]. TpT is a useful tool for diagnosing acute coronary syndrome and providing the results in approximately 15 min, but its sensitivity is relatively low, especially in the immediately after the onset of acute coronary syndrome reported by Kontos et al [ 11 ] and Smilowitz et al [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of the Aslanger Pattern to Compensate for the Limitation of ST-Elevation Myocardial Infarction (STEMI) Criteria

Miyauchi

Kuwazuru

Arikawa

et al. 2023

Cureus

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Background: ST-elevation is one of the most valuable electrocardiogram findings to diagnose acute myocardial infarction. However, more than a quarter of acute coronary occlusions are missed by this criterion, causing a delay in revascularization. Therefore, there should be awareness of the limitations of the current criteria and new electrocardiographic findings are required as a diagnostic tool to compensate for them. The Aslanger pattern is a specific electrocardiographic finding in acute inferior myocardial infarction with multivessel disease and allows the detection of inferior myocardial infarction that does not show ST-elevation, leading to rapid revascularization. However, in patients with the Aslanger pattern, the hemodynamic characteristics, such as the rate of shock and the use of mechanical circulatory support, as well as prognostic characteristics such as the in-hospital mortality rate, have not yet been clarified. Methods: In this study, we retrospectively surveyed the current practice on the basis of ST-elevation myocardial infarction (STEMI) criteria in patients with acute coronary artery occlusion presenting with inferior myocardial infarction. We examined the clinical characteristics of the Aslanger pattern. Results: Based on the STEMI criteria, 71.8% (51/72) of patients were diagnosed with STEMI from an acute electrocardiogram, and 28.2% (21/78) were diagnosed with non-STEMI. As expected, ruling out in all acute coronary artery occlusions using STEMI criteria alone was difficult. A total of 48% of patients with non-STEMI had the Aslanger pattern. In addition, 80% of patients with the Aslanger pattern had multivessel disease, 30% had the use of the mechanical circulatory support, and 20% had in-hospital mortality. Conclusion: This study suggests that the Aslanger pattern is useful not only for diagnosis, but also for predicting hemodynamic collapse and a poor prognosis. Therefore, we should share information on Aslanger pattern with other physicians and use this pattern in daily practice.

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Section: Discussionmentioning

confidence: 99%

Clinical Features of the Aslanger Pattern to Compensate for the Limitation of ST-Elevation Myocardial Infarction (STEMI) Criteria

Miyauchi

Kuwazuru

Arikawa

et al. 2023

Cureus

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“…Observational studies indeed show that the current STEMI criteria miss approximately one-third of ACOs. [ 13 14 15 16 17 18 19 20 21 ] This suggests that, when STEMI criteria are not met, the physicians do not manage to identify the patients with ACO among all patients with undifferentiated persistent chest pain partly because it may be present in many other competing diagnoses. [ 1 2 ] Furthermore, STEMI criteria were shown to have only a prospective sensitivity of 21% and 49% for ACO when a computer algorithm and cardiologist evaluation were used, respectively.…”

Section: Can a Non-st-segment Elevation Myocardial Infarction Still B...mentioning

confidence: 99%

Beyond the ST-segment in Occlusion Myocardial Infarction (OMI): Diagnosing the OMI-nous

Aslanger

2023

Turk J Emerg Med

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The ST-segment elevation (STE) myocardial infarction (MI)/non-STEMI (NSTEMI) paradigm has been the central dogma of emergency cardiology for the last 30 years. Although it was a major breakthrough when it was first introduced, it is now one of the most important obstacles to the further progression of modern MI care. In this article, we trace why a disease with an established underlying pathology (acute coronary occlusion [ACO]) was unintentionally labeled with a surrogate electrocardiographic sign (STEMI/NSTEMI) instead of pathologic substrate itself (ACO-MI/non-ACO-MI or occlusion MI [OMI]/non-OMI [NOMI] for short), how this fundamental mistake caused important clinical consequences, and why we should change this paradigm with a better one, namely OMI/NOMI paradigm.

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“…However, several reports questioned the diagnostic accuracy of traditional STEMI criteria for acute coronary occlusion [ACO] [5] , [6] . Interestingly, a new diagnostic electrocardiographic paradigm named occlusion ACO-MI/non-ACO-MI was demonstrated to be superior to STEMI criteria for the ECG diagnosis of ACO-MI in two retrospective blinded interpretations [7] , [8] . In case of suspected acute MI, it is recommended to record an ECG, with its interpretation being made within 10 min of ambulance arrival.…”

Section: Acute Myocardial Infarctionmentioning

confidence: 99%

Recent highlights on acute myocardial infarction and takotsubo syndrome from the International Journal of Cardiology: Heart & Vasculature

Tedeschi

Ammirati

Contri

et al. 2022

IJC Heart & Vasculature

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Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction

Cited by 35 publications

References 55 publications

Clinical Features of the Aslanger Pattern to Compensate for the Limitation of ST-Elevation Myocardial Infarction (STEMI) Criteria

Clinical Features of the Aslanger Pattern to Compensate for the Limitation of ST-Elevation Myocardial Infarction (STEMI) Criteria

Beyond the ST-segment in Occlusion Myocardial Infarction (OMI): Diagnosing the OMI-nous

Recent highlights on acute myocardial infarction and takotsubo syndrome from the International Journal of Cardiology: Heart & Vasculature

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