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Review
. 2021 Mar;25(3):156-162.
doi: 10.5152/AnatolJCardiol.2021.89304.

Time for a new paradigm shift in myocardial infarction

Emre K Aslanger  1 , H Pendell Meyers  2 , Stephen W Smith  3
Affiliations
Review

Time for a new paradigm shift in myocardial infarction

Emre K Aslanger et al. Anatol J Cardiol. 2021 Mar.

Abstract

The ST-elevation myocardial infarction (STEMI)/non-STEMI paradigm per the current guidelines has important limitations. It misses a substantial proportion of acute coronary occlusions (ACO) and results in a significant amount of unnecessary catheterization laboratory activations. It is not widely appreciated how poor is the evidence base for the STEMI criteria; the recommended STEMI cutoffs were not derived by comparing those with ACO with those without and not specifically designed for distinguishing patients who would benefit from emergency reperfusion. This review aimed to discuss the origins, evidence base, and limitations of STEMI/non-STEMI paradigm and to call for a new paradigm shift to the occlusion MI (OMI)/non-OMI.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
An old outline for management of acute coronary occlusion (Cook County Hospital Intern Manual, Year Book Publishers, Chicago, US, 1955).
Figure 2
Figure 2
A timeline of major events providing insights into the acute myocardial infarction pathogenesis and management.
Figure 3
Figure 3
A comparison of ST-segment elevation myocardial infarction/ non-ST-segment elevation myocardial infarction and occlusion myocardial infarction/ non-occlusion myocardial infarction paradigms using the Fibrinolytic Therapy Trialists’ meta-analysis mortality data.
See this image and copyright information in PMC

Comment in

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