Related Experiment Video
Updated: Oct 4, 2025
Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Using latent class analysis to identify clinical features of patients with occlusive myocardial infarction:
Charles Knoery1, Katie A McEwan2, Matthew Manktelow3
1Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, Centre for Health Science, University of the Highlands and Islands, Inverness, UK.
Insights
Identifying acute coronary occlusion (OMI) in myocardial infarction (MI) is challenging. Current methods fail to reliably distinguish OMI from non-OMI, leading to treatment delays and increased mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Current myocardial infarction (MI) classification relies on ST elevation (STEMI) versus non-ST elevation (NSTEMI).
- This stratification assumes ST elevation indicates acute coronary occlusion (OMI), but one-quarter of NSTEMI cases are OMI with higher mortality.
- Identifying OMI is crucial for timely and effective treatment.
Purpose of the Study:
- To identify clinical features that can reliably distinguish acute coronary occlusion (OMI) from non-occlusive myocardial infarction (MI).
Main Methods:
- Analysis of prospectively collected data from 1412 patients undergoing percutaneous coronary intervention (PCI) for acute MI.
- Latent class analysis was used to identify patterns of presentation and history associated with OMI.
Main Results:
- 263 patients were diagnosed with OMI. OMI patients had fewer comorbidities but similar cerebrovascular disease risk and increased acute mortality (4.2% vs. 1.1%).
- Nearly 30% of OMI patients experienced treatment delays, including reperfusion therapy.
- Latent class analysis did not effectively differentiate OMI from non-OMI patients based on available data.
Conclusions:
- Clinical features of OMI and STEMI are similar, but OMI/non-OMI groups showed no differences in age or cerebrovascular disease risk.
- No reliable characteristics currently exist to distinguish OMI from non-OMI.
- Treatment delays indicate OMI patients are not receiving optimal care, necessitating an alternative identification strategy.
Background:
Treatment decisions in myocardial infarction (MI) are currently stratified by ST elevation (ST-elevation myocardial infarction [STEMI]) or lack of ST elevation (non-ST elevation myocardial infarction [NSTEMI]) on the electrocardiogram. This arose from the assumption that ST elevation indicated acute coronary artery occlusion (OMI). However, one-quarter of all NSTEMI cases are an OMI, and have a higher mortality. The purpose of this study was to identify features that could help identify OMI.
Methods:
Prospectively collected data from patients undergoing percutaneous coronary intervention (PCI) was analyzed. Data included presentation characteristics, comorbidities, treatments, and outcomes. Latent class analysis was undertaken, to determine patterns of presentation and history associated with OMI.
Results:
A total of 1412 patients underwent PCI for acute MI, and 263 were diagnosed as OMI. Compared to nonocclusive MI, OMI patients are more likely to have fewer comorbidities but no difference in cerebrovascular disease and increased acute mortality (4.2% vs. 1.1%; p < .001). Of OMI, 29.5% had delays to their treatment such as immediate reperfusion therapy. With latent class analysis, while clusters of similar patients are observed in the data set, the data available did not usefully identify patients with OMI compared to non-OMI.
Conclusion:
Features between OMI and STEMI are broadly very similar. However, there was no difference in age and risk of cerebrovascular disease in the OMI/non-OMI group. There are no reliable characteristics therefore for identifying OMI versus non-OMI. Delays to treatment also suggest that OMI patients are still missing out on optimal treatment. An alternative strategy is required to improve the identification of OMI patients.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Coronary Artery Disease I: Introduction
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease II: Pathophysiology
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...