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.

STEMI 40

STEMI Cholesterol Myocardial Infarction Document 40

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?

Defibrillator 113

Defibrillator Cardiac Arrest STEMI Chest Pain 113

Dr. Smith's ECG Blog

OCTOBER 26, 2011

Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. Circulation 1999;99(15):1972-7.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

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.

STEMI 40

STEMI Heart Failure Circulation Hospital 40

Ken Grauer, MD

FEBRUARY 3, 2024

Despite the absence of significant coronary stenosis on her post-arrest cath — the ECG in Figure-1 is clearly diagnostic of an extensive anterolateral STEMI ( presumably from acute LAD [ L eft A nterior D escending ] coronary artery occlusion). The rhythm in ECG #1 is regular and supraventricular at a rate of ~75/minute.

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Blog Cardiac Arrest STEMI Plaque 164

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.

Cardiac Arrest 110

Cardiac Arrest STEMI Ischemia SCAD 110

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). There is atrial fibrillation.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MAY 19, 2020

This is a troponin I level that is almost exclusively seen in STEMI. So this is either a case of MINOCA, or a case of Type II STEMI. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. I believe the latter (type II STEMI) is most likely.

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Circulation: Cardiovascular Interventions

OCTOBER 14, 2024

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

STEMI 40

STEMI Cardiovascular Interventions Circulation 40

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

Circulation: Cardiovascular Imaging

APRIL 3, 2025

Circulation: Cardiovascular Imaging, Ahead of Print. BACKGROUND:Microvascular obstruction (MVO) is associated with heart failure (HF) following ST-segmentelevation myocardial infarction.

Heart Failure 40

Heart Failure Myocardial Infarction STEMI Risk Factors 40

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

Dr. Smith's ECG Blog

OCTOBER 8, 2024

Subtle as a STEMI." (i.e., Given that this is before it is released into the circulation by reperfusion therapy, this is a massively elevated troponin. In our study, there were 20/53 complete LAD OMI (TIMI-0 flow) which did not meet STEMI criteria. None of the 20 ever evolved to STEMI criteria. Hyperacute T-waves persist.

Cardiac Arrest 123

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock 123

Circulation: Cardiovascular Imaging

MARCH 24, 2025

Circulation: Cardiovascular Imaging, Ahead of Print. BACKGROUND:T2-weighted imaging is commonly used to measure myocardial salvage in reperfused myocardial infarction but is hindered by poor reproducibility and indistinct boundaries. Early gadolinium enhancement (EGE) emerges as an alternative for measuring the area at risk.

Myocardial Infarction 40

Myocardial Infarction STEMI Thrombolysis Cardiovascular Imaging 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. This has resulted in an under-representation of STEMI MINOCA patients in the literature. Circulation [Internet] 2017;135(16):1481–9. Circulation.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Circulation: Cardiovascular Interventions

FEBRUARY 20, 2024

Circulation: Cardiovascular Interventions, Ahead of Print.

STEMI 40

STEMI Physiology Cardiovascular Interventions Circulation 40

Dr. Smith's ECG Blog

AUGUST 19, 2023

This is diagnostic of infero-posterior OMI, but it is falsely negative by STEMI criteria and with falsely negative posterior leads (though they do show mild ST elevation in V4R). They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. Circulation 2007 2. Khan et al.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

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." Circulation , 130 (25). Immediate versus delayed invasive intervention for non-stemi patients. The case continues. Mukherjee, D.,

Myocardial Infarction 123

Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Circulation: Cardiovascular Interventions

FEBRUARY 20, 2024

Circulation: Cardiovascular Interventions, Ahead of Print. BACKGROUND:Patients with ST-segment–elevation myocardial infarction but no coronary microvascular injury are at low risk of early cardiovascular complications (ECC).

Myocardial Infarction 40

Myocardial Infarction STEMI Cardiogenic Shock Cardiac Arrest 40

Dr. Smith's ECG Blog

JANUARY 2, 2016

LVH and the diagnosis of STEMI - how should we apply the current guidelines? This one mimics inferior STEMI (Figure 4): Concentric LVH, NO wall motion abnormality Case 5. Contrast the above with this one, which has both LVH and inferior STEMI : There is limb lead LVH with superimposed inferior STEMI. They are quite rare.

Ischemia 52

Ischemia Chest Pain STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

It has been estimated that in the aggregate, they occur at a rate of about 3 per 1000 patients with acute MI, and most of these events occur in patients with STEMI. A mong patients with STEMI, ventricular septal rupture is the most common and free wall rupture is the least common.

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Cardiogenic Shock Pericarditis Chest Pain Myocardial Infarction 109

Dr. Smith's ECG Blog

AUGUST 9, 2024

The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI? Circulation Research , 56 (2), 184–194. Circulation , 63 (2), 333–340. About one hour later his high sensitivity troponin I resulted at 3,000 ng/L (reference 3-54 ng/L). What is the rhythm? Moffat, M.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

MARCH 2, 2009

By definition, this is a non-STEMI because there is not 1 mm of ST elevation in 2 consecutive leads. However, ST elevation is only an imperfect surrogate for complete acute persistent occlusion of an epicardial coronary artery without collateral circulation. It is neither fully sensitive nor specific.

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Heart Attack Heart attacks STEMI Echocardiogram 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

Step 1 to missing posterior MI is relying on the STEMI criteria. A prospective validation of STEMI criteria based on the first ED ECG found it was only 21% sensitive for Occlusion MI, and disproportionately missed inferoposterior OMI.[1] But it is still STEMI negative. A 15 lead ECG was done (below). In a study last year, 14.4%

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Open Heart

SEPTEMBER 13, 2024

This could facilitate the leakage of bacterial products into circulation and contribute to inflammation and adverse cardiac remodelling. Methods We examined 61 ST-elevation myocardial infarction (STEMI) patients who developed acute HF within 48 hours of successful percutaneous coronary intervention (PCI). to 264.65).

Cardiac Function 52

Cardiac Function Myocardial Infarction Heart Failure STEMI 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Also note that they allow ST depression c/w posterior MI to be a STEMI equivalent. Circulation 122:Abstract 101. Kurkciyan et al.

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Cardiac Arrest STEMI Hemorrhage Hospital 52

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4141170-A4141170, November 12, 2024. This study investigates the relationship between baseline 5-HTP levels and the incidence of major adverse cardiovascular events (MACE) in patients who have experienced ST-elevation myocardial infarction (STEMI).Objective:Our

Myocardial Infarction 40

Myocardial Infarction Coronary Artery Bypass Graft STEMI Angina 40

Dr. Smith's ECG Blog

AUGUST 3, 2017

The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! Posterior STEMI occurs in approximately 15-20% of acute MI, but the vast majority of the time it is seen in conjunction with inferior (Infero-Posterior) or lateral (Postero-Lateral) STEMI (1).

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

Precordial ST depression may be subendocardial ischemia or posterior STEMI. If you thought it might be a posterior STEMI, then you might have ordered a posterior ECG [change leads V4-V6 around to the back (V7-V9)]. So there was 3-vessel disease, but with an acute posterior STEMI. Circulation 2007;115(10):1306-24.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 29, 2023

But because there was no new ST elevation, the ECG was signed off as “STEMI negative” and the patient waited to be seen. But the ECG still doesn’t meet STEMI criteria. It was therefore interpreted as “no STEMI” and the patient was treated with dual anti-platelets and referred to cardiology as “NSTEMI.” the cardiologist 5.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 70

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4132742-A4132742, November 12, 2024. A random-effects model was used for outcomes with high heterogeneity.Results:We included 4 RCTs with 3173 patients comparing FFR-guided CR with culprit-only PCI in patients with STEMI and multivessel coronary artery diseases.

Coronary Artery Disease 40

Coronary Artery Disease Myocardial Infarction STEMI Thrombosis 40

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4141279-A4141279, November 12, 2024. Background:Slow flow phenomenon is impaired coronary flow during percutaneous coronary intervention (PCI) in absence of mechanical obstruction, and it is associated with deteriorated outcome.

STEMI 40

STEMI Myocardial Infarction Kidney Disease Thrombolysis 40

Dr. Smith's ECG Blog

DECEMBER 6, 2022

So they took the patient urgently to cath: 100% occlusion of inferior obtuse marginal branch of the circumflex, with collateral circulation. Had the cardiologists followed NSTEMI or transient STEMI guidelines, which recommend non-urgent cath, the patient could have redeveloped an OMI and had a worse outcome.

Chest Pain 52

Chest Pain STEMI Diabetes Circulation 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Barely any STE, and thus not meeting STEMI criteria. Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. He was given 6mg IV morphine for ongoing pain.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. The below ECG was recorded.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Ken Grauer, MD

JANUARY 20, 2024

Another overlooked OMI ( Cardiologist limited by STEMI Definition — OMI evident by Mirror Test ) — See My Comment at the bottom of the page in the September 21, 2020 post on Dr. Smith’s ECG Blog. Smith’s ECG Blog.

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Blog Bradycardia STEMI Download 95

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The "criteria" for posterior STEMI are 0.5 Is it STEMI or NonSTEMI? It was opened and stented with a door to balloon time of about 120 minutes (this is long for STEMI, but very short for a high risk Non STEMI). The 4th, after the opening of the artery and release of troponin from the cardiac circulation, was 99.9

Chest Pain 52

Chest Pain STEMI Aortic Myocardial Infarction 52