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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, October 9, 2020


R.E.B.E.L.EM - By Leen Alblaihed - October 08, 2020
Paper: Aslanger EK et al.Diagnostic Accuracy of Electrocardiogram for Acute Coronary Occlusion Resulting in Myocardial Infarction (DIFOCCULT Study). Int J Cardiol Heart Vasc 2020. PMID: 32775606
"Clinical Question: Does shifting from a STEMI/NSTEMI paradigm to a new approach (ACO-MI/ non-ACO-MI) result in better identification of the patients who need acute reperfusion therapy?
Author Conclusion: “We believe that it is time for a new paradigm shift from the STEMI/non-STEMI to the ACOMI/non-ACOMI in the acute management of MI.”
Clinical Take Home Points:
  • The title of this study was appropriate (The DIFOCCULT Trial) as the there were lots of stats that were difficult to read through
  • We agree with the author’s conclusion that a new paradigm shift should be used when considering taking patients with ischemic myocardium to the cath lab, or when considering reperfusion therapy
  • The current STEMI / non-STEMI approach is highly insensitive and has a weak evidence base. It implies that only certain ECG criteria (ST elevations) should be intervened on immediately, missing ⅓ of ACOs that would benefit from such therapy.
  • The ACOMI/ non-ACOMI approach was found to improve long term mortality and has higher sensitivity, PPV and NPV when compared to the standard STEMI/ non-STEMI approach
  • Various ECG findings (not just STE) showed correlation with ACO and should be used clinically to change the course of management for our patients from observation and troponin trending to the deserved intervention and emergent reperfusion"