STEMIs and Reperfusion Timing
Time is Muscle:
Patients with persistent symptoms and STEMIs need to receive mechanical or pharmacological treatments. In general, the faster they can get these treatments the better. With a PCI capable facility we want these patients to have treatment within 90 min of entering the hospital.
If you don’t have a cath lab they need to be transferred appropriately to STEMI facility to undergo treatment within 120 min.
If your patient is going to undergoing fibrinolytic therapy with such as tPA you ideally want to start within 30 min of arrival
What’s in the future?
Out with STEMI
In with OMI (Occlusive Myocardial Infarction)!
In 2020, Dr. Myers published in JEM, “Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI”. It looked at what differences exist between STEMI(+) OMI patients and STEMI(-) OMI patients in terms of time to catheterization and outcomes.
He found that STEMI(+)OMI went to catheterization (~40min) while STEMI(-) OMI went to catheterization in >400min. Not good!
These results support that OMI-NOMI (rather than STEMI-NSTEMI) criteria can identify more patients with ACS that have emergently salvageable myocardium and benefit from emergent therapy and intervention. It could be within our practice that we see the term STEMI disappear and OMI take it place!
Meyers HP, Bracey A, Lee D, Lichtenheld A, Li WJ, Singer DD, Kane JA, Dodd KW, Meyers KE, Thode HC, Shroff GR, Singer AJ, Smith SW. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. J Emerg Med. 2021 Mar;60(3):273-284. doi: 10.1016/j.jemermed.2020.10.026. Epub 2020 Dec 9. PMID: 33308915.
ST-Elevation Myocardial Infarction (STEMI), Occlusive Myocardial Infarction (OMI), Non ST-Elevation Myocardial Infarction (NSTEMI), Non-Occlusion Myocardial Infarction (NOMI), Percutaneous Coronary Intervention (PCI), Tissue Plasminogen Activator (tPA)