2025 STEMI Stents 
Dr. Smith's ECG Blog
MARCH 27, 2025
Theres ST elevation in V3-4 which meets STEMI criteria, which could be present in either early repolarization, pericarditis or injury. Lets see what happens in the current STEMI paradigm. Emergency physician: STEMI neg but with elevated troponin = Non-STEMI The first ECG was signed off. What do you think?
Dr. Smith's ECG Blog
FEBRUARY 16, 2025
The emergency medicine physician documented, "His initial EKG is riddled with artifact and difficult to interpret but does not look like a STEMI." The ECG remains positive for STEMI by GE. The true AV groove LCx was "jailed" by the stent and appears occluded in the post PCI image. The emergency physician consulted cardiology.
Dr. Smith's ECG Blog
APRIL 11, 2025
Here is the Queen of Hearts interpretation: Here is the cardiologist's impression: "EKG does not show a STEMI." Here is the cath report (TIMI-2 flow in the circumflex -- stented): Learning Point: Just because the cardiologist says it is "not a STEMI" and "wants to teach you about the ECG", it does not mean you should back down.
Dr. Smith's ECG Blog
MARCH 1, 2025
He reports this was similar to how he felt when he had his heart attack 4 years prior, now s/p 4 stents. Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. 2/3 of STEMI have a peak 4th generation troponin I greater than 10.0 NSTEMI-OMI").
Dr. Smith's ECG Blog
MARCH 19, 2025
Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. STEMI criteria are only 43% sensitive for OMI.
Dr. Smith's ECG Blog
JANUARY 31, 2025
This ECG pattern is my favorite example of how the STEMI criteria are fundamentally flawed. At cath there was a 100% proximal LAD occlusion, which was opened and stented. We have a series of 20 TIMI-0 LAD Occlusions that do meet STEMI criteria. There is a de Winter T- wave pattern also in lead I. Troponin T peaked at 9378 ng/L.
Dr. Smith's ECG Blog
MARCH 14, 2025
He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. At the time of this initial ED ECG, his symptoms were improving ECG #1 on admission to the ED The patient was not seen quickly in the ED as it was a busy shift and the ECG did not meet STEMI criteria. The below ECG was recorded.
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