⚠️Note:

• 25-30% of NSTEMIs are found to have total thrombotic occlusion at the time of cardiac cath (PMID 29020244)
• Mortality rates in these patients are ~2x higher than in those with non-occluded vessels (PMID 29020244)
• The Occlusion Myocardial Infarction (OMI) / Non-Occlusion Myocardial Infarction (NOMI) paradigm provides a framework for identifying patients with “NSTEMIs” who are more likely to have acute total thrombotic occlusion of a coronary artery

📕 OMI Guide:

• This guide is intended to provide a quick reference to remind you of the patterns associated with OMIs and their mimics
• Swipe left/right (on mobile) or use left/right arrow keys to quickly compare ECGs corresponding to angiographically confirmed OMIs curated from Dr. Smith’s ECG Blog:

📚 Learn More:

• OMI Manifesto

🚨 Suggestive of OMI:

• Smith-Modified Sgarbossa’s Criteria
  • Concordant STE >1 mm any lead
  • Concordant STD >1 mm V1-V3
  • Discordant STE >25% preceding S-wave in any lead
  • Discordant STE or STD >30% preceding S- or R-wave in any lead

✅ Expected STE in LBBB or V-Pacing:

• Discordant STE <1/4 S-Wave V1-V4

🚨 OMI (+) in LBBB or Paced Rhythm:

9 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 99% for excessively proportionally discordant STE >25%
• Specificity: 94% for excessively proportionally discordant STE >20% (not part of official Modified-Sgarbossa criteria)
• Specificity: 98% for excessively proportionally discordant STE or STD >30% in any lead (not part of official Modified-Sgarbossa criteria)
• Sources: PMID 22939607, PMID 34172301

⚠️Note:

• Acute OMI with preservation of LVH voltage criteria is rare
• In most cases, acute LAD OMI causes diminution of S-wave voltage in V1-V3, which makes finding examples of OMI which preserve LVH voltage criteria unusual

🚨 Suggestive of OMI:

• Discordant STE > 1/6 (17%) preceding S-wave
• STE in V1-V3 > 25% of the preceding QRS
  • This is very insensitive: STE in LVH rarely exceeds 4 mm. If an S-wave is 30 mm in depth, STE would have to exceed 7 mm to meet criteria.
• Symmetric TWI is more suggestive of ischemia (Figure from Dr. Ken Grauer )

✅ Expected ST changes in LVH:

• STE in leads with deep S waves (usually V1-V3) may mimic STEMI. This may be seen in LVH
• LVH usually has concave-upwards ST segments, but conVEX-upwards can also be seen
• LV “strain”:
  • ST-T wave changes of LV “strain” in response to marked LVH are most commonly seen in one or more of the lateral leads (ie, leads I, aVL; V4,V5,V6).
    • In its most extreme form — these changes manifest as asymmetric ST depression (ie, the ST segment descends slower than it rises)
  • Instead of seeing ST-T wave changes of LV “strain” in lateral leads — some patients manifest a “mirror-image” of strain in anterior leads
    • Use of the Mirror Test (ie, inverting the QRST complex in lead V1) may facilitate recognizing what the shape of LV “strain” may look like in a right-sided lead (such as lead V1 or V2). Example from Dr. Ken Grauer
  • Some patients with LVH (especially if the frontal plane axis is vertical) — also manifest ST-T changes of LV “strain” in the inferior leads.
• The increase in leftward and posterior forces may overshadow baseline anterior forces — with a “net result” that R wave progression is delayed (sometimes to the point of producing QS complexes in one or more anterior leads).
• Inferior STE with reciprocal ST depression in aVL is frequently found in the following STEMI mimics: LVH, LBBB, inferior LV aneurysm, myocarditis

📝 LVH Criteria:

• Sokolow-Lyon
  • [S wave V1 or V2] + [R wave V5 or V6] > 35 mm
  • Sensitivity: 14%
  • Specificity: 99%
• Modified Cornell
  • [R wave aVL] > 11 mm
  • Sensitivity: 14%
  • Specificity: 92%
• Cornell
  • [R wave in aVL] + [S wave in V3] > [28 mm for men] or [20 mm for women]
  • Sensitivity: 31%
  • Specificity: 93%
• Peguero
  • [Deepest S wave in any precordial lead] + [S wave V4] > [28 mm for men ] or [23 mm women]; if deepest S wave is in V4, double this value
  • Sensitivity: 57%
  • Specificity: 90%
• Summary Figure from Dr. Ken Grauer

🚨 OMI (+) with LVH:

2 examples below. Swipe ↔️ or use arrow keys to veiw more.

✅ OMI Mimics due to LVH:

6 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 93% if 1-mm ST-segment elevation in any contiguous leads (2 mm if leads V1–V3), and ST-segment/R-wave ratio >25% for leads V1–V3
• Source: PMID 22738872

⚠️ Note:

• LV aneurysm should be suspected when there are QS-waves in any of leads V1-V4
• A QS-wave means a single negative deflection, without any R-wave or with only a tiny r-wave.
• Only about 70%-80% of patients with the ECG morphology of “LV aneurysm” actually have an LV aneurysm, as defined by echocardiographic dyskinesis.
• “LV aneurysm” is far less common in this era of reperfusion, in which STEMI is not allowed to progress to full infarction
• LV Aneurysm can be inferior, anterior, or posterior. Inferior aneurysm looks very much like acute MI because it does not get QS-waves, but rather QR-waves, which can also be present in acute MI.

🚨 Suggestive of OMI:

• T/QRS ratio > 0.36 in any of leads V1 – V4

✅ Expected changes in LV Aneurysm:

• In acute coronary occlusion, the T-wave is large, whereas in LV aneurysm, the T-wave is not so large. There are two pretty accurate formulas:
  • T/QRS ratio < 0.36 in any of leads V1 – V4
• • [TV1 + TV2 + TV3 + TV4] divided by [QRS V1 + QRS V2 + QRS V3 + QRS V4] < 0.22

🚨 OMI (+) with LV Aneurysm:

4 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 81% if there is one lead of V1-V4 in which the T/QRS ratio is greater than 0.36
  • In this case, OMI is the likely diagnosis, though subacute OMI is also possible
• Source: PMID 15915398 (Derivation)
• Source: PMID 25862248 (Validation)

⚠️ Note:

• 30-60% of anterior OMIs do NOT have reciprocal STD in inferior leads (Sources: PMID 8213517, PMID 10440150, PMID 8682009, PMID 11195604)
• The 🔢 4 Variable Formula can help distinguish subtle LAD occlusion from early repolarization
  • It is critical to use it only when the differential is subtle LAD occlusion vs. early repol
• There must be ST Elevation of at least 1 mm in any of leads V2-V4.
  • If there is LVH, it may not apply. If there are features that make LAD occlusion obvious (inferior or anterior ST depression, convexity, terminal QRS distortion, Q-waves, or ST Elevation of 5 mm or more), then the formula MAY NOT apply. These kinds of cases were excluded from the study as they were recognized as obvious anterior STEMI.

🚨 Suggestive of OMI:

• 4 variable formula value >18.2
• Terminal QRS distortion

✅ Suggestive of “Benign” Early Repolarization:

• Early repolarization always has prominent R-waves in V2-V4 (Source)

🚨 OMI (+) Subtle Anterior STE

7 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 100% specific for LAD occlusion when there is terminal QRS distortion
• Specificity: 94.7% specific for OMI when 4 variable formula value >18.2
• Source: PMID 28460689
• Source: PMID 27658331

🚨 Suggestive of OMI:

• Any STD in AVL
• Any reciprocal STD
• STE in lead III > STE in lead II

✅ Suggestive of Pericarditis:

• Diffuse STE without reciprocal STD (except in V1 or AVR)
• STE in lead II > STE in lead III

🚨 OMI (+) Mimics of Pericarditis:

2 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 100% specific for OMI if any STD in AVL
• Source: PMID 26542793

⚠️ Note:

• Pulse Tapping Artifact is caused by rhythmic tapping of an arterial pulse or cardiac pulsatation to an overlying electrode. If the culprit electrode is one of the extremity electrodes (as is frequently the case) the standard leads using this electrode show abnormal waves coinciding with ST-segment or T-waves. Notably, the remaining standard lead will be spared.

✅ Suggestive of Pulse Taping Artifiact:

• Diffuse, bizarre ST-segments or T-waves in all but one lead (usually I, II or III)

✅ OMI (-) mimics from artifact:

6 examples below. Swipe ↔️ or use arrow keys to veiw more.

⚠️ Note:

• Wellens’ syndrome is a syndrome of Transient OMI, in which the ECG was not recorded at the time of the anginal pain, but only after spontaneous resolution of the pain, at which time the ECG shows reperfusion T-waves in the LAD distribution. 
  • Pattern A = terminal T-wave inversion (biphasic)
  • Pattern B shows deep symmetric T-wave inversion. 
• Wellens’ syndrome also requires preservation of R-waves

🚨 OMI (+) Wellens Examples:

10 examples below. Swipe ↔️ or use arrow keys to veiw more.

⚠️ OMI (-) Wellens Mimic | RH Strain:

6 examples below. Swipe ↔️ or use arrow keys to veiw more.

⚠️ OMI (-) Wellens Mimic | Takotsubo:

7 examples below. Swipe ↔️ or use arrow keys to veiw more.

⚠️ Note:

• In cases of limited inferior wall injury, the ST vector of inferior MI localizes the area of infarction and is typically directed inferiorly and rightwards (yellow arrow)
• The ST vector of subendocardial ischaemia does not localize to the ischaemia and regardless of involved coronary region directs to lead aVR (blue arrow)
• The resultant average ST vector directs rightwards, causing ST elevation only in lead III and aVR (red arrow)

🚨 Aslanger pattern:

The following pattern may indicated a limited inferior OMI with multivessel disease in the right clinical context:

• STE only in lead III
• ST segment in V1 > V2
• ST-depression (STD) in V4-V6, with a positive/terminally positive T-wave

🚨 OMI (+) Aslanger Pattern:

1 examples below. Swipe ↔️ or use arrow keys to veiw more.

⚠️ Note:

• High lateral STEMI is associated with a pattern of ST elevation caused by acute occlusion of the first diagonal branch of the left anterior descending coronary artery (LAD-D1).
• With the 4×3 display of the 12-lead ECG, the location of the most impressive ST deviations resemble the shape of the South African flag

🚨 South African Flag :

• STE in I, aVL, (+/-) V2
• STD or TWI in III (or other inferior leads)

🚨 OMI (+) South African Flag Pattern:

2 examples below. Swipe ↔️ or use arrow keys to veiw more.

🚨 Suggestive of OMI:

• Terminal QRS Distortion:
  • Terminal QRS (TQRSD) distortion in V2 or V3 is a specific finding for LAD occlusion when trying to differentiate from early repolarization
  • When the differential is LAD occlusion vs early repolarization, TQRSD was 100% specific for LAD occlusion in 171 cases
  • TQRSD is defined by ABSENCE of BOTH S-wave (reaching below isoelectric/PR) and J-wave (elevation of J-point above ST segment) in V2 or V3
• Any STE or hyperacute T wave in inferior leads (especially lead III) associated with any STD in aVL
• Any STD depression in inferior leads with associated STE in aVL

🚨 OMI (+) Terminal QRS Distortion:

7 examples below. Swipe ↔️ or use arrow keys to veiw more.

🚨 OMI (+) Subtle Anterior STE:

7 examples below. Swipe ↔️ or use arrow keys to veiw more.

🚨 OMI (+) Subtle Inferior STE:

12 examples below. Swipe ↔️ or use arrow keys to veiw more.

🚨 OMI (+) Subtle STE in AVL:

5 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 100% specific for LAD occlusion when there is terminal QRS distortion (PMID 27658331)
• Specificity: 94.7% specific for OMI when 4 variable formula value >18.2 (PMID 28460689)

🚨 Suggestive of OMI:

• STD maximal in leads V1-V4
  • This is in contrast to if STD is maximal out to V5 and V6 which may indicate severe supply-demand imbalance due to critical multivessel or left main acute coronary syndrome, hypovolemia or severe anemia which may not indicate acute coronary occlusion
• STE in posterior leads V7-V9

🚨 OMI (+) Posterior OMI:

11 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• Specificity: 97% specific for OMI when STD maximal in V1-V4
  • Of the 99 OMIs detected by STDmaxV1-4, 34% had <1mm STD, and 47 (47%) had accompanying STEMI criteria
  • Source: PMID 34775811
• Specificity: 84% specific for posterior OMI when STE in V7-V9 and STD in V1-V3
  • Sensitivity: 80% (with respect to diagnostic accuracy of posterior involvement (at least severe hypokinesia on TTE)
  • 46 of 87 inferior MIs with posterior leads had posterior ST elevation of at least 0.5 mm in 2 consecutive leads of V7-V9
  • Significant STD in V1-V3 was noted in 52 patients (60%)
  • Source: PMID 9502627

🚨 Suggestive of OMI:

• STD (especially with J-point depression) preceding large, hyperacute T waves in the precordial leads
  • The presence of de Winter’s T-waves indicates a complete or near complete occlusion of a proximal LAD
• To illustrate the spectrum of ECG findings in deWinter pattern — the authors of the original 2008 NEJM manuscript included a composite picture taken from 8 representative tracings of patients in their study who manifested deWinter T waves.

🚨 OMI (+) de Winter's Examples:

11 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Specificity:

• PPV: 95.2% (95% confidence interval: 76.2-99.9%), 100% (69.2-100.0%) and 100% (51.7-100%) in the three respective diagnostic studies with primary outcome was defined as at least 70% angiographic stenosis of a major epicardial vessel.(PMID 28362646)

🚨 Suggestive of OMI:

• Hyperacute T-waves currently have no formal ECG definition, but expert consensus and existing literature agree that they are likely best defined by increased AUC of the T-wave in proportion to the QRS amplitude (or perhaps QRS area).
• Subjectively, this corresponds to T-waves that are abnormally large by area (both height and width), bulky, and abnormally symmetric, as if being physically inflated, but all relative to QRS size.
• Objectively, increased AUC of the T-wave relative to the QRS has been shown by the following 2 quantifiable elements: 1) longer corrected QT interval, 2) greater T-wave to QRS amplitude ratio.
• An additional feature of hyperacute T-waves is increased and abnormal T-wave symmetry, which has not yet been well quantified.
  • Evolution of hyperacute T wave Example
• Learn more about hyperacute T waves from this great review: 📄 PMID 36872197 – Smith, Stephen W., and Harvey Pendell Meyers. “Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined.” Annals of Emergency Medicine (2023).

✅ Mimics of hyperacute T wave:

• Reciprocal reperfusion T-waves (see example):
  • How can you tell if a large upright wave is hyperacute or if it is reciprocal to an inverted wave? Answer: You can tell mostly based on the state of the patient. If the patient is symptomatic (should usually be chest pain), then the large fat T-wave is hyperacute. Serial ECGs should show evolution to STEMI in that lead. If, on the other hand, the patient is now pain free, then the ischemia is in the territory of the inverted T-wave and that is a reperfusion T-wave. The hyperacute T-wave is only a reciprocal view.
  • How can you tell if a large upright wave is hyperacute or if it is reciprocal to an inverted wave? Answer: You can tell mostly based on the state of the patient. If the patient is symptomatic (should usually be chest pain), then the large fat T-wave is hyperacute. Serial ECGs should show evolution to STEMI in that lead. If, on the other hand, the patient is now pain free, then the ischemia is in the territory of the inverted T-wave and that is a reperfusion T-wave. The hyperacute T-wave is only a reciprocal view.

🚨 OMI (+) Inferior Hyperacute T-waves:

7 examples below. Swipe ↔️ or use arrow keys to veiw more.

🚨 OMI (+) Anterior Hyperacute T-waves:

15 examples below. Swipe ↔️ or use arrow keys to veiw more.

🚨 OMI (+) Lateral Hyperacute T-waves:

3 examples below. Swipe ↔️ or use arrow keys to veiw more.

🔎 Where to measure ST Elevation:

• At the J-point
  • According to the Fourth Universal Definition of Myocardial Infarction (2018) the magnitude of ST elevation should be determined using the J-point (junction between QRS termination and ST-segment onset)

🔎 Where to measure ST Baseline:

• At the QRS onset
  • According to the Fourth Universal Definition of Myocardial Infarction (2018) the QRS onset should be used as the reference point.
  • They note that in patients with a stable baseline, the TP segment (isoelectric interval) is a more accurate method to assess the magnitude of ST-segment shift.
  • Tachycardia and baseline shift are common in the acute setting and can make this determination difficult. Therefore, QRS onset is recommended as the reference point for J-point determination
• No clinical trial of reperfusion therapy has designated a method of measurement of ST elevation.
  • Because the PR segment may be normally depressed as part of the atrial repolarization wave, and that wave extends to the J-point, then if measured at the J-point, the ST segment should be measured relative to the PR segment.
  • If the ST segment is measured at 60 to 80 ms after the J-point (a point used in prior trials), it should be measured relative to the TP segment.
  • Measuring at 60-80 ms after the J-point, results in dramatically higher values (Source: PMID 16531592)

📺 MEDIA RESOURCES

• Selected Cases of OMI on the ECG
  • August, 2023 – Presented by Dr. Stephen Smith
  • Video – 62 min
• Advances in Occlusion Myocardial Infarction Detection
  • May, 2023 – Mayo Clinic Interview with Dr. Pendell Meyers
  • Audio – 23 min
• OMI/NOMI vs STEMI/STEMI – Where We Are and Where We’re Going
  • May, 2023 – Presented by Dr. Mark Hellerman
  • Video – 32 min
• STEMI/NSTEMI and OMI/NOMI Paradigms
  • March, 2022 – Mayo Clinic Interview with Dr. Stephen Smith
  • Video – 32 min
• The OMI Manifesto
  • June, 2019 – Presented by Dr. Pendell Meyers
  • Video – 54 min
• Let’s Replace STEMI-NSTEMI with OMI-NOMI
  • July, 2022 – Mayo Clinic Grand Rounds presented by Dr. Stephen Smith
  • Video – 61 min

📚 TEXT RESOURCES

• Dr Smiths ECG Blog
• OMI Manifesto
• Aslanger, Emre K., H. Pendell Meyers, and Stephen W. Smith. “Recognizing electrocardiographically subtle occlusion myocardial infarction and differentiating it from mimics: Ten steps to or away from cath lab.” Turk Kardiyoloji Dernegi Arsivi 49.6 (2021): 488. 

👨‍🏫 TEST YOURSELF

• The OMI Quizzes via Get The Gas
• James McCabe’s 36 ECG challenge
  • Evaluate your ability to use the 12-Lead ECG to make the diagnosis of a coronary artery occlusion using a standardized list of 36 ECG’s from McCabe James McCabe’s paper below:
  • Source: McCabe, James M., et al. “Physician accuracy in interpreting potential ST‐segment elevation myocardial infarction electrocardiograms.” Journal of the American Heart Association 2.5 (2013): e000268. PMID 24096575

📱 MOBILE APPS

• OMI Toolbox  (Apple)
• OMI Toolbox (Android)

👸 QUEEN OF HEARTS ❤️

• Queen of Hearts
  • Get an app that leverages an artificial intelligence model trained to detect acute coronary occlusion on any 12-lead ECG image with high precision

Q-wave / Non-Q-wave Dichotomy

• 1941: Q-waves noted as a distinguishing feature of “acute coronary occlusion” compared to “acute coronary insufficiency with infarction”
  • Master, Arthur M., et al. “Differentiation of acute coronary insufficiency with myocardial infarction from coronary occlusion.” Archives of Internal Medicine 67.3 (1941): 647-657.
    
• 1980: The terms “Q-wave” and “Non-Q-wave” infarctions were reportedly first coined
  • PMID 8421361: Spodick, David H. “Q-Wave vs Non—Q-Wave Infarction: An Oversimplified Dichotomy.” JAMA 269.5 (1993): 590-590.
    • “The terms ‘Q-wave’ and ‘non-Q-wave’ infarctions were first coined in a letter by respected cardiologists. Unfortunately, this terminology, probably due to its distinguished provenance, was rapidly taken up by clinicians and investigators.”
      
• 1983: Q-wave vs Non-Q-wave recognized as an oversimplified dichotomy
  • PMID 6829457: Spodick, David H. “Q-wave infarction versus ST infarction. Nonspecificity of electrocardiographic criteria for differentiating transmural and nontransmural lesions.” Am J Cardiol 51 (1983): 913-915.
    • “Whatever the reason for continued confusion regarding their anatomic extent, the pseudospecificty of Q and S-T myocardial infarctions remains a lasting myth … False terminology does more than semantic damage: it does conceptual damage. If we continue to accept a Q infarct as dependably indicating a transmural lesion, we can inhibit consideration of what it really does mean … Given the ultimate nonspecificity of many electrocardiographic findings it should not be surprising that they overlap to such a a degree that “transmural” and “nontransmural” are gross misnomers.”
      
• 1988: Q-Wave vs Non-Q-Wave recognized as an oversimplified dichotomy
  • PMID: 3414524: Spodick, David H. “Comprehensive electrocardiographic analysis of acute myocardial infarction by individual and combined waveforms.” The American Journal of Cardiology 62.7 (1988): 465-467.
    • “The ‘Q’ versus ‘non-Q’ dichotomy is inadequate for clinicopatholologic and prognostic electrocardiographic classification of acute myocardial infarction. All individual and appropriate combinations of waveforms, their distributions and temporal behavior must be characterized with due regard for the many confounding factors outlined”
      
• 1992: Q-Wave vs Non-Q-Wave recognized as an oversimplified dichotomy
  • PMID 1518115: Moss, Arthur J. “Q-Wave vs Non—Q-Wave Myocardial Infarction: An Oversimplified Dichotomy.” JAMA 268.12 (1992): 1595-1596.
    • “The Q-wave vs non-Q-wave categorization does not provide sufficiently sensitivity, specificity, or predictive accuracy about the subsequent clinical course of patients with a first myocardial infarction to use it as reliable data in the clinical decision making process.”

STEMI / NSTEMI Dichotomy

Evolution of STEMI criteria:

• 1994: 1mm in all leads – STEMI “millimeter criteria” are born
  • PMID 7905143: FTT meta-analysis
    
• 2000: Increased to 2mm in V1-V3
  • PMID 10987628: 📕 1st Universal Definition of MI
  • PMID 11781962: Macfarlane: Age, Sex, ST Segments
    
• 2004: Back to 1mm everywhere
  • PMID 15358045: 📕 ACC/AHA STEMI Guidelines
  • PMID 15534817: Macfarlane 20204
    
• 2007: V2 and V2 now have ♂ / ♀ difference
  • PMID 18036459: 📕 2nd Universal Definition of MI
    
• 2009: V2 and V3 now have ♂ / ♀ and age difference
  • PMID 01928193: 📕 AHA/ACCF/HRS Standardization and Interpretation of Electrocardiogram (Wagner and Macfarlane)
    
• 2012: No changes to STEMI criteria
  • PMID 22958960: 📕 3rd Universal Definition of MI
    
• 2018: No changes to STEMI criteria
  • PMID 30571511: 📕 4th Universal Definition of MI
  • Introduce guidance on points from which to measure ST segment

OMI / NOMI Dichotomy

• 2014: “The False STEMI – NonSTEMI Dichotomy” term is coined
  • Dr. Smith begins lecturing on “The False STEMI – NonSTEMI Dichotomy“
  • SMACC 2014 Video Recording
    
• 2018: “OMI / NOMI” term coined via Twitter poll
  • Post #1, Post #2
    
• 2018: “The OMI Manifestos” is published
  • The OMI Manifesto
    
• 2019: Prospective, real-world evidence showing the gap between ST elevation myocardial infarction (STEMI) and occlusion MI (OMI)
  • PMID 31331673: Meyers, H. Pendell, and Stephen W. Smith. “Prospective, real-world evidence showing the gap between ST elevation myocardial infarction (STEMI) and occlusion MI (OMI).” International Journal of Cardiology 293 (2019): 48-49.
    
• 2021: STEMI(-) OMI patients noted with significant delays to catheterization but adverse outcomes more similar to STEMI(+) OMI than those with no occlusion.
  • PMID 33308915: Meyers, H. Pendell, et al. “Comparison of the ST-elevation myocardial infarction (STEMI) vs. NSTEMI and occlusion MI (OMI) vs. NOMI paradigms of acute MI.” The Journal of emergency medicine 60.3 (2021): 273-284.
    
• 2021: Blinded interpretation using predefined OMI ECG findings found to be superior to STEMI criteria for the ECG diagnosis of Occlusion MI
  • PMID 33912650: Meyers, H. Pendell, et al. “Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction.” IJC Heart & Vasculature 33 (2021): 100767.
    
• 2021: Step-by-step approach to OMI diagnosis proposed by Drs. Aslanger, Meyers and Smith
  • PMID 34523597: Aslanger, Emre K., H. Pendell Meyers, and Stephen W. Smith. “Recognizing electrocardiographically subtle occlusion myocardial infarction and differentiating it from mimics: Ten steps to or away from cath lab.” Turk Kardiyoloji Dernegi Arsivi 49.6 (2021): 488.
    
• 2022: The ACC endorses the following “STEMI Equivalents”: 1) LBBB or VP-rhythm with Sgarbossa or Smith-modified Sgarbossa Criteria; 2) Hyperacute T Waves; 3) Posterior STEMI; 4) De Winter Sign
  • PMID 36241466: 📕 Writing Committee, et al. “2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: a report of the American College of Cardiology solution set oversight committee.” Journal of the American College of Cardiology 80.20 (2022): 1925-1960.
    
• 2023:
  • PMID 37061867: Zoni, Cesar R., Debabrata Mukherjee, and Martha Gulati. “Proposed new classification for acute coronary syndrome: Acute coronary syndrome requiring immediate reperfusion.” Catheterization and Cardiovascular Interventions (2023).
    
• 2023: A machine learning model demonstrated superiority in detecting subtle ischemic ECG changes indicative of OMI in an observer-independent approach
  • PMID 36778371: Al-Zaiti, Salah, et al. “Machine Learning for the ECG Diagnosis and Risk Stratification of Occlusion Myocardial Infarction at First Medical Contact.” (2023).
    
• 2023: STEMI criteria found to miss the majority of OMI
  • PMID 34967919: McLaren, Jesse TT, et al. “Missing occlusions: Quality gaps for ED patients with occlusion MI.” The American Journal of Emergency Medicine (2023).