Time for a new paradigm shift in myocardial infarction

Area of Science:

• Cardiology
• Medical Diagnostics
• Clinical Guidelines

Background:

• Current ST-elevation myocardial infarction (STEMI) guidelines have limitations.
• The STEMI criteria may miss a significant proportion of acute coronary occlusions (ACO).
• This can lead to unnecessary cardiac catheterization laboratory activations.

Purpose of the Study:

• To review the origins and evidence base of the STEMI/non-STEMI paradigm.
• To discuss the limitations of current STEMI diagnostic criteria.
• To advocate for a new paradigm based on occlusion myocardial infarction (OMI).

Main Methods:

• Literature review of current cardiology guidelines and evidence.
• Analysis of the limitations of STEMI diagnostic criteria.
• Discussion of the proposed OMI/non-OMI paradigm.

Main Results:

• The evidence base for STEMI criteria is weak and not designed for emergency reperfusion selection.
• Current criteria result in missed ACO and unnecessary procedures.
• A shift to an OMI/non-OMI paradigm is suggested.

Conclusions:

• The STEMI/non-STEMI classification has significant limitations in identifying acute coronary occlusions.
• A new occlusion MI (OMI) paradigm is needed for improved diagnosis and treatment.
• This shift aims to better select patients who will benefit from emergency reperfusion.