Academic Outcomes STEMI 
Dr. Smith's ECG Blog
MAY 31, 2023
Cath lab declined as it is not a STEMI." And now this finding is even formally endorsed as a "STEMI equivalent" in the 2022 ACC guidelines!!! Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mindset. Opiates are associated with worse outcomes in Myocardial Infarction. Cath attending is aware.
Dr. S. Venkatesan MD
SEPTEMBER 1, 2024
It is a sad academic story ,most of the interventional cardiology community shrugged it off as a non-event. No one knows how the pPCI related delay was legally ratified and academically accepted by the elite cardiology forums. best, It has a miniscule 1 % edge in the outcome if performed on time, at a expertise intensive place.
Dr. Smith's ECG Blog
JUNE 13, 2024
See this post: Septal STEMI with ST elevation in V1 and V4R, and reciprocal ST depression in V5, V6. After being transferred to an academic center, she was taken to the cath lab: Proximal RCA occlusion (causing inferior and RV OMI) Unfortunately, she continued to decline despite aggressive measures. Also seen in inferior + RV OMI.)
Dr. Smith's ECG Blog
AUGUST 2, 2024
This was a machine read STEMI positive OMI. the investigators reviewed outcomes in 118 patients presenting with NSTEMI. 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.
Dr. Smith's ECG Blog
SEPTEMBER 10, 2023
Post Cath ECG: Obviously completing MI with LVA morphology, and STE that meets STEMI criteria (but pt is still diagnosed as "NSTEMI"). Day 12 ECG: FINAL DIAGNOSIS: "NSTEMI" Despite the fact that his day 4 ECG easily meets STEMI criteria, the patient is diagnosed as NSTEMI. Long term outcome unknown but obviously bleak.
Dr. Smith's ECG Blog
DECEMBER 11, 2023
Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Immediate versus delayed invasive intervention for non-stemi patients. Academic Emergency Medicine 27(S1): S220; May 2020.
EMS 12-Lead
MARCH 19, 2023
It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. Could there have been a different outcome if the crews immediately recognized OMI – versus a shortened PR-interval – and commenced with pre-hospital Cath Lab activation? Is this OMI?
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