Missing occlusions: Quality gaps for ED patients with occlusion MI

• DOI: 10.1016/j.ajem.2023.08.022
• Publication Date: 2023-08-15T23:00:05Z
• Authors: Jesse T.T. McLaren; Mazen El-Baba; Varunaavee Sivash...; H. Pendell Meyers; Stephen W. Smith; Lucas B. Chartier
• Keywords: TIMI; Culprit; ST elevation; Troponin T

ST-elevation Myocardial Infarction (STEMI) guidelines encourage monitoring of false positives (Code STEMI without culprit) but ignore negatives (non-STEMI with occlusion myocardial infarction [OMI]). We evaluated the hospital course emergency department (ED) patients acute coronary syndrome (ACS) using vs OMI paradigms.This retrospective chart review examined all ACS admitted through two academic EDs, from June 2021 to May 2022, categorized as 1) (acute culprit lesion TIMI 0-2 flow, or 3 flow and peak troponin I >10,000 ng/L; or, if no angiogram, ng/L new regional wall motion abnormality), 2) NOMI (Non-OMI, i.e. MI OMI) 3) MIRO (MI ruled out: elevation). Patients were stratified by admission for STEMI. Initial ECGs reviewed automated interpretation "STEMI", admission/discharge diagnoses compared.Among 382 patients, there 141 OMIs, 181 NOMIs, 60 MIROs. Only 40.4% OMIs STEMI: 60.0% had "STEMI" on ECG, median door-to-cath time was 103 min (IQR 71-149). But 59.6% not 1.3% ECG (p < 0.001) 1712 1043-3960; p 0.001). While 13.9% STEMIs positive a different discharge diagnosis, 32.0% Non-STEMIs still discharged "Non-STEMI."STEMI criteria miss majority OMI, highlight never negative The paradigm reveals quality gaps opportunities improvement.