The STEMI/NonSTEMI Dichotomy needs to be replaced by Occlusion MI vs. Non-Occlusion MI

Aslanger, Emre; Meyers, H. Pendell; Bracey, Alexander; Smith, Stephen W.

doi:10.1016/j.ijcard.2021.02.015

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…There has been concern that a significant portion of patients not presenting with STEMI ECGs show an acute coronary occlusion in coronary angiography [ 37 , 38 , 39 , 40 ]. A recent study compared STEMI ECGs and non-STEMI ECGs for patients with acute coronary occlusion on coronary angiography and found that ED arrival to catheterization time is significantly delayed in patients with non-STEMI ECGs, while adverse outcomes are similar between the two groups [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

Choi

Kim

et al. 2022

JCM

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Background: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed. Methods: This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min. Results: A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80–122) vs. 81 (70–88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632–13.490, p = 0.004). Conclusions: DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

Choi

Kim

et al. 2022

JCM

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“…This vulnerable group, in contrast to ACS with an open artery (Extended Data Fig. 1 ), suffers from unnecessary diagnostic and treatment delays that are associated with higher mortality 14 – 17 . This excess risk can be mitigated with enhanced diagnostic criteria.…”

Section: Mainmentioning

confidence: 99%

Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction

Al‐Zaiti

Martin‐Gill

Zègre‐Hemsey

et al. 2023

Nat Med

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Patients with occlusion myocardial infarction (OMI) and no ST-elevation on presenting electrocardiogram (ECG) are increasing in numbers. These patients have a poor prognosis and would benefit from immediate reperfusion therapy, but, currently, there are no accurate tools to identify them during initial triage. Here we report, to our knowledge, the first observational cohort study to develop machine learning models for the ECG diagnosis of OMI. Using 7,313 consecutive patients from multiple clinical sites, we derived and externally validated an intelligent model that outperformed practicing clinicians and other widely used commercial interpretation systems, substantially boosting both precision and sensitivity. Our derived OMI risk score provided enhanced rule-in and rule-out accuracy relevant to routine care, and, when combined with the clinical judgment of trained emergency personnel, it helped correctly reclassify one in three patients with chest pain. ECG features driving our models were validated by clinical experts, providing plausible mechanistic links to myocardial injury.

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“…1), suffers from unnecessary diagnostic and treatment delays that are associated with higher mortality. [15][16][17][18] This excess risk can be mitigated with enhanced diagnostic criteria. Although important ECG signatures of OMI are frequently described in the literature, [19][20][21][22] they are subtle, involve the entire QRST complex, and are spatial in nature (i.e., changes diluted across multiple leads).…”

Section: Introductionmentioning

confidence: 99%

Machine Learning for the ECG Diagnosis and Risk Stratification of Occlusion Myocardial Infarction at First Medical Contact

Al‐Zaiti

Martin‐Gill

Zègre‐Hemsey³

et al. 2023

Preprint

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Patients with occlusion myocardial infarction (OMI) and no ST-elevation on presenting ECG are increasing in numbers. These patients have a poor prognosis and would benefit from immediate reperfusion therapy, but we currently have no accurate tools to identify them during initial triage. Herein, we report the first observational cohort study to develop machine learning models for the ECG diagnosis of OMI. Using 7,313 consecutive patients from multiple clinical sites, we derived and externally validated an intelligent model that outperformed practicing clinicians and other widely used commercial interpretation systems, significantly boosting both precision and sensitivity. Our derived OMI risk score provided superior rule-in and rule-out accuracy compared to routine care, and when combined with the clinical judgment of trained emergency personnel, this score helped correctly reclassify one in three patients with chest pain. ECG features driving our models were validated by clinical experts, providing plausible mechanistic links to myocardial injury.

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The STEMI/NonSTEMI Dichotomy needs to be replaced by Occlusion MI vs. Non-Occlusion MI

Cited by 6 publications

References 2 publications

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction

Machine Learning for the ECG Diagnosis and Risk Stratification of Occlusion Myocardial Infarction at First Medical Contact

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