O MI! A STEMI Paradigm Shift PDF
Transcript of O MI! A STEMI Paradigm Shift PDF
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O MI! A STEMI Paradigm Shift?
Mark Keuchel, DO
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Disclosures: I have no relevant financial relationships with the manufacturer(s)
of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use
of a commercial product/device in my presentation
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Learning Objectives: 1. Review history of reperfusion
2.Understand why STEMI/NSTEMI dichotomy may be inadequate
3.Introduce the term Occlusion Myocardial Infarction
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Q-WAVE
NON Q-WAVE
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FIBRINOLYTIC THERAPY TRIALISTS’
1994
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60,000 PATIENTS
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60,000 PATIENTS
THROMBOLYTICS VS. PLACEBO
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NNT=56
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4 OF 9NO ECG CRITERIA
1/3 NO STE
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SUBGROUP ANALYSIS
NNT=43
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REPERFUSION ERA
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SO WHAT NEXT?
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FIBRINOLYTIC THERAPY TRIALISTS’
1994
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ACC/AHA GUIDELINES FOR
UNSTABLE ANGINA
2000
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EUROPEAN HEART JOURNAL
2000
>2MM STE IN ANTEROSEPTAL LEADS
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ACC/ESC 1ST UNIVERSAL
DEFINITION OF MI
2000
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ACC/ESC 1ST UNIVERSAL
DEFINITION OF MI
>2MM STE IN V1-V3 >1MM STE ALL OTHERS
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MACFARLANE ET AL
2001
AGE AND SEX DETERMINANTS
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3MM
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ACC/AHA STEMI GUIDELINES
2004
>1MM STE IN ANY TWO CONTIGUOUS LEADS
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MACFARLANE ET AL
2004
IN-DEPTH CRITERIA FOR STE
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MACFARLANE ET AL
2004
2.3 FOR AVL AND I 3.5 FOR II, AVF, III
2.5 FOR V1-V4
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MACFARLANE ET AL
2004
“CERTAIN OTHER RESTRICTIONS
APPLY”
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ACC/ESC 2ND UNIVERSAL
DEFINITION OF MI
2007
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ACC/ESC 2ND UNIVERSAL
DEFINITION OF MI1 STE IN 2 CONTIGUOUS LEADS
EXCEPT V2-V3 WHICH IS 1.5 FOR WOMEN AND 2 FOR MEN
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AHA/ACCF/HRS
2009
CURRENT STEMI GUIDELINES
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CURRENT STEMI GUIDELINES
V2-V3 >2.5 MEN <40 V2-V3 >2 MEN >40 V2-V3 >1.5 WOMEN
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ACC/ESC 3RD UNIVERSAL
DEFINITION OF MI
2012
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25-30%
NSTEMI DIAGNOSIS MISSES
ACUTE CORONARY OCCLUSIONS
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SCHMITT ET AL
2001
29%
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KOYAMA ET AL
2002
47%
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KHAN ET AL
2007
25.5%
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WANG ET AL
2009
27%
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FROM ET AL
2010
28%
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PRIDE ET AL
2010
26.2%
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SMITH ET AL
2012
22%
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MARTI ET AL
2014
18%
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MEYERS ET AL
2020
234
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MEYERS ET AL2020
23467 STEMI
167 NSTEMI
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MEYERS ET AL2020
234108 OMI 126 NOMI
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MEYERS ET AL
2021
265
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MEYERS ET AL2021
265146 (55%)
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1. SUBTLE STE 2. HYPERACUTE T WAVE 3. RECIPROCAL ST
DEPRESSION 4. ST DEPRESSION
MAXIMAL IN V1-V4
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5. SUSPECTED ACUTE Q WAVE
6. TERMINAL QRS DISTORTION
7. ANY STE IN INFERIOR LEADS
8. + MODIFIED SGARBOSSA
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REFRACTORY ISCHEMIA EXCLUDED
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STEMI
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OMIOCCLUSION MYOCARDIAL INFARCTION