Myocardial Infarction, STEMI and Thrombolysis

Enhancing microcirculation in STEMI patients: can intracoronary thrombolysis combined with thrombus aspiration provide an optimal strategy?

Frontiers in Cardiovascular Medicine

MARCH 28, 2025

ST-elevation myocardial infarction (STEMI) is a critical cardiovascular emergency characterized by acute coronary artery occlusion and subsequent myocardial injury. The current standard of care is primary percutaneous coronary intervention (PPCI), which aims to rapidly restore epicardial blood flow.

Thrombolysis

Thrombolysis STEMI Myocardial Infarction Article

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Heart BMJ

JULY 10, 2024

Background Despite restoration of epicardial blood flow in acute ST-elevation myocardial infarction (STEMI), inadequate microcirculatory perfusion is common and portends a poor prognosis. IC thrombolysis was associated with a significantly lower incidence of MACE (RR=0.65, 95% CI 0.51 to 2.67; I 2 =25%; p<0.0001).

Myocardial Infarction

Myocardial Infarction Thrombolysis STEMI Outcomes

Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Introduction Differences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. vs. 1.8 ± 5.1%, p = 0.002). vs. 1.8 ± 5.1%, p = 0.002).

Myocardial Infarction

Myocardial Infarction SCAD STEMI Thrombolysis

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Age-associated declined function of endothelial progenitor cells and its correlation with plasma IL-18 or IL-23 concentrations in patients with ST-segment elevation myocardial infarction

Frontiers in Cardiovascular Medicine

MAY 24, 2024

BackgroundST-segment elevation myocardial infarction (STEMI) persists to be prevalent in the elderly with a dismal prognosis. Nevertheless, the influence of aging on the functionality of EPCs in STEMI is not fully understood.MethodThis study enrolled 20 younger STEMI patients and 21 older STEMI patients.

Myocardial Infarction

Myocardial Infarction STEMI Thrombolysis

Determinants and Prognostic Value of Early Gadolinium Enhancement-Derived Myocardial Salvage Index in STEMI

Circulation: Cardiovascular Imaging

MARCH 24, 2025

BACKGROUND:T2-weighted imaging is commonly used to measure myocardial salvage in reperfused myocardial infarction but is hindered by poor reproducibility and indistinct boundaries. The median MSI was 35.0% (interquartile range, 22.959.5%), with smaller MSI observed in patients with larger infarcts (P<0.001).

Myocardial Infarction

Myocardial Infarction STEMI Thrombolysis Cardiovascular Imaging

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

Patient still not having chest pain however this is more concerning for OMI/STEMI. Wellens' syndrome is a syndrome of Transient OMI (old terminology would be transient STEMI). A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Dr. S. Venkatesan MD

SEPTEMBER 1, 2024

“ Since Intravenous lysis looks too simplistic, that do not need expertise, and lacks a commercial trail, it is wrongly depicted as inferior management strategy in STEMI “ Every one of us is equally responsible for this sorry state of affairs. In this context, we need a movement to revive the pre-hospital thrombolysis.

Thrombolysis

Thrombolysis Myocardial Infarction Academic STEMI

Until “Pre-hospital PCI” becomes a reality …this is not possible.

Dr. S. Venkatesan MD

MARCH 3, 2025

Is primary PCI superior to thrombolysis in the first hour of STEMI ? Steg PG, Bonnefoy E, Chabaud S, Lapostolle F, Dubien PY, Cristofini P, Leizorovicz A, Touboul P; Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. No, it is not. Read ref 1, 2.

Hospital

Hospital Angioplasty Myocardial Infarction Thrombolysis

An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Smith : there is some minimal ST elevation in V2-V6, but does not meet STEMI criteria. Transient STEMI has been studied and many of these patients will re-occlude in the middle of the night. Timing of revascularization in patients with transient ST segment elevation myocardial infarction: a randomized clinical trial.

Chest Pain

Chest Pain Myocardial Infarction STEMI Pericarditis

Right precordial ST depression in a patient with chest pain

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

Chest Pain Myocardial Infarction STEMI Ischemia

A Tough ECG, But Learn From It!

Dr. Smith's ECG Blog

JUNE 18, 2013

His ECG was repeated at this point: This shows a well developed anterior STEMI. To not see these findings is very common, and this patient would be given the diagnosis of NonSTEMI, with subsequent development of STEMI. It is not a missed STEMI, but it is a missed coronary occlusion. The peak troponin I was over 100.

STEMI

STEMI Chest Pain Myocardial Infarction Webinar

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

MARCH 9, 2013

Here is the prehospital ECG, with pain: Hyperacute anterolateral STEMI The medics had activated the cath lab and the patient went for angiogram and had a 95% stenotic LAD with TIMI-3 flow. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. A stent was placed. de Zwaan C.,

Chest Pain

Chest Pain Myocardial Infarction Ischemia Angina

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Circulation

NOVEMBER 11, 2024

Methods:STEMI patients who underwent coronary revascularization therapy and cardiac magnetic resonance (CMR) at about 4 days and 6 months between 2017 and 2023 were included.

STEMI

STEMI Myocardial Infarction Kidney Disease Thrombolysis

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

Appearance of abnormal Q waves early in the course of acute myocardial infarction: implications for efficacy of thrombolytic therapy. cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." These do NOT indicate late, subacute MI. Raitt MH, et al. LV Thrombus , 1.5

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? Harhash AA, Huang JJ, Reddy S, et al.

Ischemia

Ischemia STEMI Stenosis Chest Pain

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analys is.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

If you had recorded an ECG during chest pain, what would it have shown?

Dr. Smith's ECG Blog

JUNE 28, 2018

Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. See these posts for Wellens' mimics: Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH) Anterior STEMI? Am Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Article

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

There is clearly sufficient STE for STEMI criteria in leads V2 and aVL, but lead I has less than 1.0 mm of STE - thus, technically this ECG does not meet STEMI criteria, although it is a quite obvious OMI. This ECG was immediatel y discussed with the on-call cardiologist who said the ECG was "concerning but not a STEMI."

Chest Pain

Chest Pain SCAD STEMI Blog

What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?

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.

Chest Pain

Chest Pain STEMI Myocardial Infarction Ischemia

What is Wellens' syndrome? And what conditions mimic it?

Dr. Smith's ECG Blog

APRIL 2, 2025

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J 2000;139(3):4306. A stent was placed.

Chest Pain

Chest Pain STEMI Myocardial Infarction Stents

Cardiovascular Update

Enhancing microcirculation in STEMI patients: can intracoronary thrombolysis combined with thrombus aspiration provide an optimal strategy?

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Webinars

Age-associated declined function of endothelial progenitor cells and its correlation with plasma IL-18 or IL-23 concentrations in patients with ST-segment elevation myocardial infarction

Determinants and Prognostic Value of Early Gadolinium Enhancement-Derived Myocardial Salvage Index in STEMI

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Until “Pre-hospital PCI” becomes a reality …this is not possible.

An elderly male with shortness of breath

Right precordial ST depression in a patient with chest pain

A Tough ECG, But Learn From It!

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

If you had recorded an ECG during chest pain, what would it have shown?

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?

What is Wellens' syndrome? And what conditions mimic it?

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