Dr. Smith's ECG Blog

JUNE 7, 2024

Obvious infero-postero-lateral STEMI(+)OMI, regardless of context Now let’s put them in order: what was the sequence? With serial ECGs that are ‘STEMI negative’ the physician could have waited for serial troponin levels or referred the patient as “non-STEMI”. What was the outcome and final diagnosis?

Chest Pain 112

Chest Pain STEMI Outcomes Document 112

Dr. Smith's ECG Blog

APRIL 18, 2024

I sent this to the Queen of Hearts So the ECG is both STEMI negative and has no subtle diagnostic signs of occlusion. Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1]

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STEMI Chest Pain Myocardial Infarction Blog 121

DAIC

OCTOBER 7, 2024

tim.hodson Mon, 10/07/2024 - 14:45 Oct. 7, 2024 — The Society for Cardiovascular Angiography & Interventions (SCAI) recently announced the publication of the Expert Consensus Statement on the Management of Patients with STEMI Referred for Primary PCI.

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STEMI Catheterization Laboratory Best Practices Document 40

DAIC

APRIL 6, 2024

The Minneapolis Heart Institute Foundation (MHIF) is presenting leading research focused on trends in ST-elevation myocardial infarction (STEMI), the most severe form of a heart attack, at the American College of Cardiology’s Annual Scientific Session (ACC.24), 24), being held April 6-8 in Atltanta, GA.

Heart Attack 52

Heart Attack Heart attacks Risk Factors Research 52

American College of Cardiology

AUGUST 31, 2024

The use of physiology-guided complete revascularization is superior to a culprit-only strategy for older patients with either STEMI or NSTEMI, according to a prespecified substudy of the FIRE trial presented at ESC Congress 2024 in London and simultaneously published in JACC.

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STEMI Physiology Article 40

All About Cardiovascular System and Disorders

MAY 26, 2024

Immediate Microvascular Physiology After Mechanical Coronary Reperfusion of STEMI. 2024 May, 83 (21) 2077–2079. 2024 May, 83 (21) 2066–2076. MRR = (CFR/FFR) × (P a,rest /P a,hyper ) References Michel Zeitouni, Ghilas Rahoual, Gilles Montalescot, and the ACTION study group. J Am Coll Cardiol. van Leeuwen, Stephen P. Zimmermann.

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STEMI Outcomes Coronary Artery Disease Myocardial Infarction 52

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4142231-A4142231, November 12, 2024. Background:Little is known about the clinical relevance of interleukin (IL)-6 and the severity of patients with acute ST-elevation myocardial infarction (STEMI). All information about clinical and paraclinical parameters was recorded.

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STEMI Myocardial Infarction Tricuspid Biomarkers 40

Dr. Smith's ECG Blog

MARCH 10, 2025

If we took this as the gold standard, we would conclude that the computer interpretation was safe and accurate at least accurate enough to not miss STEMI, and that physicians should not be interrupted to interpret it, because there would be no change in patient management. What is the gold standard for ECG interpretation: patient outcome!!!

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Chest Pain Outcomes STEMI Electrocardiogram 89

Nature Reviews - Cardiology

APRIL 22, 2024

Nature Reviews Cardiology, Published online: 23 April 2024; doi:10.1038/s41569-024-01035-9 Data from the DanGer Shock trial demonstrate that implantation of a microaxial flow pump in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock increases the survival rate compared with standard care alone.

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Cardiogenic Shock STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

So this NSTEMI was likely a STEMI(-)OMI with delayed reperfusion. The patient was admitted as ‘NSTEMI’ which is supposed to represent a non-occlusive MI, but the underlying pathophysiology is analogous to a transient STEMI. West J Emerg Med 2024). Fortunately the patient did not reocclude while awaiting the angiogram.

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Chest Pain STEMI Aneurysm Stents 117

Dr. Smith's ECG Blog

AUGUST 11, 2024

While STEMI negative, the ECG is diagnostic of proximal LAD occlusion. Transient STEMI” are often managed like non-STEMI with delayed angiography, which is very risky. This case is an example of the steps we can all take in daily practice as the paradigm shifts from STEMI to OMI.

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Chest Pain STEMI Bradycardia Stents 100

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. How do you explain the anterior STEMI(+)OMI immediately after ROSC evolving into posterior OMI 30 minutes later? This caused a type 2 anterior STEMI.

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Cardiac Arrest STEMI Ischemia SCAD 110

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4147134-A4147134, November 12, 2024. Introduction:Elevated LDL cholesterol is linked to microvascular injury and adverse cardiac events in STEMI patients. This study examines the impact of prior statin use on LDL levels at the time of MI, focusing on NSTEMI and STEMI patients.

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STEMI Cholesterol Myocardial Infarction Document 40

Ken Grauer, MD

APRIL 26, 2024

IMPRESSION: In this patient who presents with severe, new-onset CP — today's ECG is diagnostic of an extensive, ongoing antero-lateral STEMI. ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ).

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Blog STEMI Aneurysm AFIB 155

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4141319-A4141319, November 12, 2024. Background:The computational pressure-fluid dynamics applied to index of microcirculatory resistance, derived from coronary angiography (CPFD-caIMR) is a promising alternative method of IMR to evaluate the prognosis of STEMI patients.

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STEMI Heart Failure Circulation Hospital 40

Dr. Smith's ECG Blog

AUGUST 16, 2024

Its hard to measure the STE in I exactly with the moving baseline, but there is almost certainly not enough STE to meet STEMI criteria. The ACC recognizes these findings as formal STEMI equivalents (though they do not define how to find them). They are symmetric, fat, convex on both sides, etc. 13 post.

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Chest Pain STEMI Blog 112

Ken Grauer, MD

JUNE 14, 2024

Prompt cath is therefore advised if the post-ROSC shows an acute STEMI. To Emphasize: The phenomenon of T-QRS-D is not needed in today's case to recognize the acute STEMI. The decision of whether to cath patients with a less definitive post-ROSC ECG is less clear.

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Blog STEMI Cardiac Arrest Tachycardia 155

Dr. Smith's ECG Blog

JUNE 27, 2024

COACT: The COACT trial was fatally flawed, and because of it, many cardiologists are convinced that if there are no STEMI criteria, the patient does not need to go to the cath lab. N Engl J Med [Internet] 2019;Available from: [link] Should all patients with shockable arrest be taken to angiography regardless of STEMI or No STEMI?

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Defibrillator Cardiac Arrest STEMI Chest Pain 113

Dr. Smith's ECG Blog

AUGUST 2, 2024

This was a machine read STEMI positive OMI. The meaning of this quote is that at times, something as obvious as the dramatic anterior lead ST elevation that we see in today's tracing is not the result of an acute LAD STEMI. His ECG is shown below. Pretty obvious anterior current of injury. What would you guess is the culprit artery?

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STEMI Ischemia Blog Chest Pain 119

American College of Cardiology

SEPTEMBER 1, 2024

An invasive treatment strategy involving coronary angiography and revascularization plus medical therapy did not significantly lower the composite risk of cardiovascular death or nonfatal myocardial infarction (MI) compared with a conservative strategy of medical therapy alone in older adults with NSTEMI, according to findings from the SENIOR-RITA (..)

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STEMI Myocardial Infarction Article 44

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Written by Bobby Nicholson What do you think of this “STEMI”? Second, although there is a lot of ST Elevation which meets STEMI criteria, especially in V3-4, the ST segment is extremely upwardly concave with very large J-waves (J-point notching). With EMS, patient had a GCS of 3 and was saturating 60% on room air. ng/mL and 0.10

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STEMI Document Blog Ischemia 116

Nature Reviews - Cardiology

APRIL 1, 2024

Nature Reviews Cardiology, Published online: 02 April 2024; doi:10.1038/s41569-024-01020-2 In ST-segment elevation myocardial infarction, the role of interventional modification of thrombi in the coronary arteries before stenting is controversial.

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STEMI Myocardial Infarction Embolism Stents 40

Dr. Smith's ECG Blog

JANUARY 20, 2024

This patient does not show up in the STEMI registry, and the time to reperfusion will likely not be identified as the problem that it was. The STEMI registry will show very high sensitivity of the ECG for STEMI, obscuring the fact the STEMI has low sensitivity for OMI Queen of Hearts sees it easily, like readers of the blog would.

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Chest Pain STEMI Hypertension Blog 121

The American Journal of Cardiology

MARCH 21, 2024

Publication date: Available online 21 March 2024 Source: The American Journal of Cardiology Author(s): Dániel Tornyos, Réka Lukács, András Jánosi, András Komócsi

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STEMI 52

Circulation: Cardiovascular Interventions

OCTOBER 14, 2024

Circulation: Cardiovascular Interventions, Volume 17, Issue 10 , Page e014689, October 1, 2024.

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STEMI Cardiovascular Interventions Circulation 40

Dr. Smith's ECG Blog

MAY 13, 2024

This ECG is highly concerning for LAD occlusion despite it not showing a STEMI criteria. You can find the variables used to calculate the value on MD calc here: [link] Utilizing Dr. Smith’s Subtle Anterior STEMI Calculator (4-Variable), the value is greater than 18.2 which is concerning for LAD occlusion.

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Chest Pain STEMI Ultrasound Heart Attack 120

The American Journal of Cardiology

JULY 3, 2024

Publication date: Available online 2 July 2024 Source: The American Journal of Cardiology Author(s): Sara J. King, Rajiv Patel, Sameer Arora, George A.

Risk Factors 40

Risk Factors STEMI Outcomes 40

Dr. Smith's ECG Blog

OCTOBER 8, 2024

Subtle as a STEMI." (i.e., Here is the bottom line of the article: It is widely believed that hyperacute T-waves are a transitional state preceding ST Elevation 1–4 Thus, it is tempting to postulate that early cases of OMI will eventually evolve to STEMI; yet, our data contradicts that notion. This one is easy for the Queen.

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Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock 123

Dr. Smith's ECG Blog

JUNE 11, 2024

Now it is a full blown STEMI of 3 myocardial territories: inferior, posterior, and lateral But at least it does not call it "Normal." Learning Points: You cannot trust conventional algorithms even to find STEMI(+) OMI, even when they say "normal ECG." At this point — a STEMI was diagnosed, and cardiac cath with PCI was performed.

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Chest Pain STEMI Blog Exercise 113

Ken Grauer, MD

MAY 28, 2024

My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr. Anthony Kashou. 2:00 — Dr. Kashou to Dr. Grauer: "In 2024 — Where do you see computerized ECG interpretations and AI?" How much "human oversight" is needed?

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Blog Arrhythmia Tachycardia CME 133

Circulation: Cardiovascular Interventions

APRIL 15, 2024

Circulation: Cardiovascular Interventions, Volume 17, Issue 4 , Page e014078, April 1, 2024.

STEMI 40

STEMI Cardiovascular Interventions Circulation 40

Dr. Smith's ECG Blog

OCTOBER 17, 2024

The prehospital and ED computer interpretation was inferior STEMI: There’s normal sinus rhythm, first degree AV block and RBBB, normal axis and normal voltages. The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. Vitals were normal except for oxygen saturation of 94%. Vitals were normal.

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Chest Pain STEMI Pulmonary Embolism 73

The American Journal of Cardiology

DECEMBER 22, 2024

Publication date: Available online 22 December 2024 Source: The American Journal of Cardiology Author(s): Sahib Singh, Udaya S Tantry, Young-Hoon Jeong, Paul A Gurbel

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STEMI 40

Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. The two cases were considered: Patient 1 was recognized by the ED provider and the cardiologist as having resolved “STEMI”. He wrote most of it and I (Smith) edited.

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Chest Pain STEMI Echocardiogram Stents 116

Circulation: Cardiovascular Imaging

NOVEMBER 29, 2024

Circulation: Cardiovascular Imaging, Volume 17, Issue 12 , Page e017611, December 1, 2024.

STEMI 40

STEMI Cardiovascular Imaging Circulation 40

Ken Grauer, MD

MAY 16, 2024

ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

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Blog STEMI 161

The American Journal of Cardiology

NOVEMBER 15, 2024

Publication date: Available online 14 November 2024 Source: The American Journal of Cardiology Author(s): Aiham Albaeni, Shuang Li, Yong Shan, Ravi Thakker, Diann E. Gaalema, Ritika Saxena MPH, Yong-fang Kuo, Hani Jneid, James Goodwin

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STEMI Outcomes 40