The following is a summary of “Missing occlusions: Quality gaps for ED patients with occlusion MI,” published in the November 2023 issue of Emergency Medicine by McLaren, et al.

For a study, researchers sought to evaluate the hospital course of patients with acute coronary syndrome (ACS) using both the ST-elevation myocardial infarction (STEMI) and occlusion myocardial infarction (OMI) paradigms, specifically focusing on false positives (Code STEMI without culprit) and false negatives (non-STEMI with OMI).

Conducted as a retrospective chart review, the study included all ACS patients admitted through two academic emergency departments from June 2021 to May 2022. Patients were categorized into three groups: OMI, NOMI (MI without OMI), or MIRO (MI ruled out: no troponin elevation). The cohort was stratified based on admission for STEMI, and the automated interpretation of “STEMI” on initial electrocardiograms (ECGs) was reviewed. Admission and discharge diagnoses were meticulously compared.

Among the 382 patients studied, 141 were classified as OMI, 181 as NOMI, and 60 as MIRO. Notably, only 40.4% of OMI cases were admitted as STEMI, with 60.0% having “STEMI” on ECG. The median door-to-cath time for these cases was 103 minutes. Conversely, 59.6% of OMI cases were not admitted as STEMI, with only 1.3% having “STEMI” on ECG (P < 0.001). The median door-to-cath time for these cases was significantly prolonged at 1,712 minutes (P < 0.001). False positives accounted for 13.9% of STEMIs, leading to a different discharge diagnosis. Strikingly, 32.0% of non-STEMIs had OMI but were erroneously discharged as “Non-STEMI.”

The STEMI paradigm was found to overlook the majority of OMI cases, underscoring the need for improvement in ACS patient management. The study identified quality gaps, emphasizing the importance of considering false negatives (OMI) in addition to false positives (STEMI) to enhance clinical outcomes in ACS patients.

Source: sciencedirect.com/science/article/pii/S0735675723004382