Missing occlusions: Quality gaps for ED patients with occlusion MI

• Published in: The American journal of emergency medicine 2023-11, Vol.73, p.47-54
• Main Authors: McLaren, Jesse T.T., El-Baba, Mazen, Sivashanmugathas, Varunaavee, Meyers, H. Pendell, Smith, Stephen W., Chartier, Lucas B.
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Acute coronary syndromes; Automation; Cardiovascular disease; Classification; Coronary vessels; Electrocardiogram; Electrocardiography; Emergency medical care; Heart attacks; Ischemia; Lesions; Medical imaging; Myocardial infarction; Occlusion; Occlusion myocardial infarction; ST-segment myocardial infarction; Troponin I; Ultrasonic imaging
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.08.022

ST-elevation Myocardial Infarction (STEMI) guidelines encourage monitoring of false positives (Code STEMI without culprit) but ignore false negatives (non-STEMI with occlusion myocardial infarction [OMI]). We evaluated the hospital course of emergency department (ED) patients with acute coronary syndrome (ACS) using STEMI vs OMI paradigms. This retrospective chart review examined all ACS patients admitted through two academic EDs, from June 2021 to May 2022, categorized as 1) OMI (acute culprit lesion with TIMI 0–2 flow, or acute culprit lesion with TIMI 3 flow and peak troponin I >10,000 ng/L; or, if no angiogram, peak troponin >10,000 ng/L with new regional wall motion abnormality), 2) NOMI (Non-OMI, i.e. MI without OMI) or 3) MIRO (MI ruled out: no troponin elevation). Patients were stratified by admission for STEMI. Initial ECGs were reviewed for automated interpretation of “STEMI”, and admission/discharge diagnoses were compared. Among 382 patients, there were 141 OMIs, 181 NOMIs, and 60 MIROs. Only 40.4% of OMIs were admitted as STEMI: 60.0% had “STEMI” on ECG, and median door-to-cath time was 103 min (IQR 71–149). But 59.6% of OMIs were not admitted as STEMI: 1.3% had “STEMI” on ECG (p