REBEL EM - By Shyam Murali - February 08, 2021
Paper: Myers HP et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI. Paradigms of Acute MI. Journal of Emergency Medicine 2020. PMID: 33308915
“Clinical Question: What differences exist between STEMI(+) OMI patients and STEMI(-) OMI patients in terms of time to catheterization and outcomes?
Author Conclusions:
“STEMI(-) OMI patients had significant delays to catheterization but adverse outcomes more similar to STEMI(+) OMI than those with no occlusion. these data support the OMI/NOMI paradigm and the importance of further research into emergent repercussion for STEMI(-) OMI.”
Clinical Take Home Point:
The STEMI-NSTEMI paradigm still misses a significant number of actúe coronary occlusion events that could benefit from emergent invasive intervention and a new model could improve our ability to identify them more accurately. Additionally, the OMI-NOMI paradigm would move us away from depending solely on ST elevation millimeter criteria for rapid treatment.
These results support that OMI-NOMI (rather than STEMI-NSTEMI) criteria can identify more patients with ACS that have emergently salvageable myocardium that would benefit from emergent invasive intervention and at the same time identify patients where emergent invasive intervention is of minimal benefit. STEMI(-) OMI are an under identified subgroup of ACS patients and this is now the second paper published that really helps push the needle to a OMI-NOMI paradigm shift.”