Back to Search
Start Over
Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction
- Source :
- International Journal of Cardiology. Heart & Vasculature, International Journal of Cardiology: Heart & Vasculature, Vol 33, Iss, Pp 100767-(2021)
- Publication Year :
- 2021
- Publisher :
- Elsevier, 2021.
-
Abstract
- Highlights • Acute coronary occlusions without ST elevation criteria suffer double mortality without reperfusion. • ECG findings other than ST elevation criteria can identify occlusion myocardial infarction sooner and more accurately. • Our results justify further research to evaluate the external validity of advanced ECG interpretation.<br />Objective In the STEMI paradigm of Acute Myocardial Infarction (AMI), many NSTEMI patients have unrecognized acute coronary occlusion MI (OMI), may not receive emergent reperfusion, and have higher mortality than NSTEMI patients without occlusion. We have proposed a new OMI vs. Non-Occlusion MI (NOMI) paradigm shift. We sought to compare the diagnostic accuracy of OMI ECG findings vs. formal STEMI criteria for the diagnosis of OMI. We hypothesized that blinded interpretation for predefined OMI ECG findings would be more accurate than STEMI criteria for the diagnosis of OMI. Methods We performed a retrospective case-control study of patients with suspected acute coronary syndrome. The primary definition of OMI was either 1) acute TIMI 0–2 flow culprit or 2) TIMI 3 flow culprit with peak troponin T ≥1.0 ng/mL or I ≥10.0 ng/mL. Results 808 patients were included, of whom 49% had AMI (33% OMI; 16% NOMI). Sensitivity, specificity, and accuracy of STEMI criteria vs Interpreter 1 using OMI ECG findings among 808 patients were 41% vs 86%, 94% vs 91%, and 77% vs 89%, and for Interpreter 2 among 250 patients were 36% vs 80%, 91% vs 92%, and 76% vs 89%. STEMI(−) OMI patients had similar infarct size and mortality as STEMI(+) OMI patients, but greater delays to angiography. Conclusions Blinded interpretation using predefined OMI ECG findings was superior to STEMI criteria for the ECG diagnosis of Occlusion MI. These data support further investigation into the OMI vs. NOMI paradigm and suggest that STEMI(−) OMI patients could be identified rapidly and noninvasively for emergent reperfusion using more accurate ECG interpretation.
- Subjects :
- Acute coronary syndrome
medicine.medical_specialty
STE, ST-segment elevation
NSTEMI, Non-ST-segment elevation myocardial infarction
ACS, Acute coronary syndrome
030204 cardiovascular system & hematology
Acute coronary syndromes
Culprit
MSC, Modified Sgarbossa Criteria
03 medical and health sciences
Electrocardiography
0302 clinical medicine
ED, Emergency department
Internal medicine
OMI, Occlusion myocardial infarction
Occlusion
medicine
Diseases of the circulatory (Cardiovascular) system
STD, ST-segment depression
030212 general & internal medicine
Myocardial infarction
cardiovascular diseases
Original Paper
Troponin T
medicine.diagnostic_test
business.industry
ECG, Electrocardiogram
MIRO, Myocardial Infarction Ruled Out
STEMI, ST-segment elevation myocardial infarction
medicine.disease
VPR, Ventricular Paced Rhythm
AMI, acute myocardial infarction
LBBB, Left Bundle Branch Block
surgical procedures, operative
ST elevation myocardial infarction
Coronary occlusion
RC666-701
Cardiology
NOMI, Non-occlusion myocardial infarction
Cardiology and Cardiovascular Medicine
business
TIMI
Occlusion myocardial infarction
Subjects
Details
- Language :
- English
- ISSN :
- 23529067
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- International Journal of Cardiology. Heart & Vasculature
- Accession number :
- edsair.doi.dedup.....b9289335d0aea508c3accfd6784e95ca