Contributor: Travis Barlock, MD

Educational Pearls:

The presence of a STEMI has traditionally been used to determine if a patient with acute chest pain requires urgent cath lab management

STEMI indicates an occluded coronary artery, and urgent intervention is needed to restore perfusion to ischemic tissue

Patients with occluded coronary arteries can present with EKG findings other than STEMI
2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department was recently published in the Journal of the American College of Cardiology

Recognizes STEMI equivalents that necessitate cath lab management

ST depression in precordial leads

Indicates a posterior infarct/possible RCA occlusion

LBBB c ST elevation meeting modified Sgarbossa criteria
Hyperacute and/or De Winter T wave

First indication of coronary artery occlusion
Most beneficial time to initiate cath lab because more tissue is salvageable

These recommendations will likely alter clinical practice for ED management of acute chest pain

References

Kontos MC, de Lemos JA, Deitelzweig SB, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Oct 6 2022;doi:10.1016/j.jacc.2022.08.750

Meyers HP, Bracey A, Lee D, et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. J Emerg Med. Mar 2021;60(3):273-284. doi:10.1016/j.jemermed.2020.10.026

Tziakas D, Chalikias G, Al-Lamee R, Kaski JC. Total coronary occlusion in non ST elevation myocardial infarction: Time to change our practice? Int J Cardiol. Apr 15 2021;329:1-8. doi:10.1016/j.ijcard.2020.12.082

Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD

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Podcast 826: STEMI Equivalents