ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review

被引:0
|
作者
Ricci, Fabrizio [1 ,2 ,3 ]
Martini, Chiara [1 ]
Scordo, Davide Maria [1 ]
Rossi, Davide [1 ]
Gallina, Sabina [1 ]
Fedorowski, Artur [4 ,5 ]
Sciarra, Luigi [6 ]
Chahal, C. Anwar A. [7 ,8 ,9 ]
Meyers, H. Pendell [10 ]
Herman, Robert [11 ,12 ,13 ]
Smith, Stephen W. [14 ,15 ]
机构
[1] G Annunzio Univ Chieti Pescara, Dept Neurosci Imaging & Clin Sci G Annunzio, Chieti, Italy
[2] SS Annunziata Polyclin Univ Hosp, Univ Cardiol Div, Chieti, Italy
[3] G Annunzio Univ Chieti Pescara, Inst Adv Biomed Technol, Chieti, Italy
[4] Karolinska Inst, Karolinska Univ Hosp, Dept Cardiol, Solna, Stockholm, Sweden
[5] Karolinska Inst, Dept Med, Solna, Stockholm, Sweden
[6] Univ Aquila, Dept Clin Med Publ Hlth Life & Environm Sci, Ple Salvatore Tommasi 1, Coppito, AQ, Italy
[7] WellSpan Hlth, Ctr Inherited Cardiovasc Dis, Lancaster, PA USA
[8] Mayo Clin, Div Cardiovasc Dis, Rochester, MN USA
[9] Barts Hlth NHS Trust, Barts Heart Ctr, London, England
[10] Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC USA
[11] Univ Naples Federico II, Dept Adv Biomed Sci, Naples, Italy
[12] Onze Lieve Vrouw Hosp, Cardiovasc Ctr Aalst, Aalst, Belgium
[13] Powerful Med, Samorin, Slovakia
[14] Univ Minnesota, Dept Emergency Med, Minneapolis, MN USA
[15] Hennepin Healthcare, Dept Emergency Med, Minneapolis, MN USA
关键词
Acute Coronary Syndrome; Acute Myocardial Infarction; OMI; STEMI; NSTEMI; ST-SEGMENT ELEVATION; ACUTE CORONARY SYNDROMES; BUNDLE-BRANCH BLOCK; DELAYED INVASIVE INTERVENTION; EARLY REPOLARIZATION; PRIMARY ANGIOPLASTY; IMMEDIATE; REPERFUSION; CRITERIA; OUTCOMES;
D O I
10.1016/j.annemergmed.2024.11.019
中图分类号
TU [建筑科学];
学科分类号
0813 ;
摘要
The traditional management of acute coronary syndrome has relied on the identification of ST-segment elevation myocardial infarction (STEMI) as a proxy of acute coronary occlusion. This conflation of STEMI with acute coronary occlusion has historically overshadowed non-ST-segment elevation myocardial infarction (NSTEMI), despite evidence suggesting 25% to 34% of NSTEMI cases may also include acute coronary occlusion. Current limitations in the STEMI/NSTEMI binary framework underscore the need for a revised approach to chest pain and acute coronary syndrome management. The emerging paradigm distinguishing occlusion myocardial infarction from nonocclusion myocardial infarction (NOMI) seeks to enhance diagnostic accuracy and prognostic effect in acute coronary syndrome care. This approach not only emphasizes the urgency of reper fusion therapy for high-risk ECG patterns not covered by current STEMI criteria, but also emphasizes the broader transition from viewing acute coronary syndrome as a disease defined by the ECG to a disease defined by its underlying pathology, for which the ECG is an important but insufficient surrogate test. This report outlines the emerging occlusion myocardial infarction paradigm, detailing specific ECG patterns linked to acute coronary occlusion, and proposes a new framework that could enhance triage accuracy and treatment strategies for acute coronary syndrome. Although further validation is required, the occlusion myocardial infarction pathway holds promise for earlier acute coronary occlusion detection, timely cath lab activation, and improved myocardial salvage-offering potentially significant implications for both clinical practice and future research in acute coronary syndrome management. [Ann Emerg Med. 2025;85:330-340.]
引用
收藏
页码:330 / 340
页数:11
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