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From Q/Non-Q Myocardial Infarction to STEMI/NSTEMI: Why It's Time to Consider Another Simplified Dichotomy; a

Grigorios Avdikos1, George Michas2, Stephen W Smith3

  • 1Department of Cardiology, Bioiatriki Healthcare Group, 132 Kifisias Ave. & Papada st., 11526, Athens, Greece.

Archives of Academic Emergency Medicine
|November 25, 2022
PubMed

Insights

Many non-ST-segment elevation myocardial infarction (NSTEMI) patients have acute total coronary occlusion (ATO), requiring urgent reperfusion. Current ST-segment elevation myocardial infarction (STEMI) criteria may miss these critical cases, delaying treatment.

Area of Science:

  • Cardiology
  • Medical Diagnostics

Background:

  • Acute coronary syndromes (ACSs) are classified as ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) based on electrocardiogram (ECG) findings.
  • STEMI typically indicates acute total coronary occlusion (ATO) requiring emergent reperfusion, while NSTEMI is presumed to involve subendocardial infarction without ATO.

Purpose of the Study:

  • To review the frequency and cardiovascular outcomes of ATO in NSTEMI patients.
  • To discuss ECG patterns indicative of ATO in NSTEMI patients that may not meet STEMI criteria.
  • To advocate for a revised classification of ACSs.

Main Methods:

  • Literature review of articles examining ATO in NSTEMI patients.
  • Analysis of ECG patterns associated with ATO in suspected myocardial infarction cases.
  • Discussion of current STEMI/NSTEMI classification limitations.

Main Results:

  • A significant proportion of NSTEMI patients exhibit ATO, contrary to traditional understanding.
  • Under-recognition of specific ECG patterns associated with ATO in NSTEMI leads to delayed reperfusion therapy.
  • Current STEMI criteria can misdiagnose "Pseudo-STEMI" when STE is considered out of clinical context.

Conclusions:

  • The current STEMI/NSTEMI classification may not accurately reflect underlying coronary occlusion status.
  • A new paradigm, Occlusion Myocardial Infarction (OMI)/Non-Occlusion Myocardial Infarction (NOMI), is proposed to better guide reperfusion therapy.
  • Revision of ACS classification is needed to improve timely diagnosis and management of patients with ATO.

Keywords:
Acute coronary syndromecoronary occlusionmyocardial infarctionmyocardial reperfusionnon-ST elevated myocardial infarction

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