ACUTE MYOCARDIAL INFARCTION WITH CORONARY OCCLUSION WITHOUT ST-SEGMENT ELEVATION: A SYSTEMATIC LITERATURE REVIEW
DOI:
https://doi.org/10.56238/levv17n59-029Keywords:
Myocardial Infarction, Coronary Occlusion, Non-ST-Segment Elevation Myocardial Infarction, ElectrocardiographyAbstract
The current paradigm for Acute Myocardial Infarction (AMI), based on the STEMI/NSTEMI dichotomy, fails to identify approximately 30% of acute coronary occlusions (ACO) that do not present with millimeter ST-segment elevation. Objective: To analyze the literature on Myocardial Occlusion (ACO) without ST-segment elevation, comparing its morbidity and mortality and diagnostic criteria with the traditional model. Methodology: Systematic literature review following the PRISMA protocol in the PubMed and SciELO databases (2015-2026), using the terms "Occlusion Myocardial Infarction", "NSTEMI" and "STEMI equivalents". Results: Studies were included that demonstrate that STEMI criteria have a sensitivity of only 43% to 62% for detecting acute occlusion. Patients with non-ST-segment elevation myocardial infarction (NSTEMI-negative) suffer significant delays in catheterization (median > 400 min vs. 41 min in STEMI) and have a 30-day mortality rate of 7.29%, statistically higher than patients without occlusion. New electrocardiographic patterns (Aslanger, De Winter, Precordial Whirlpool) and artificial intelligence show superior accuracy. Conclusion: The transition to the NSTEMI/NOSTEMI paradigm is urgent to mitigate the undertreatment of critically ill patients erroneously classified as low risk.
Downloads
References
ALENCAR, J. N. D. et al. Além do Paradigma IAMCSST-IAMSSST: Proposta do Instituto Dante Pazzanese para o Diagnóstico de Oclusão Coronariana Aguda. Arquivos Brasileiros de Cardiologia, [s. l.], v. 121, n. 5, p. e20230733, 2024. https://doi.org/10.36660/abc.20230733.
AYYAD, Mohammed et al. Reevaluating STEMI: The Utility of the Occlusive Myocardial Infarction Classification to Enhance Management of Acute Coronary Syndromes. Current Cardiology Reports, v. 27, n. 1, p. 75, dez. 2025.
BAE, SungA et al. Early Invasive Strategy Based on the Time of Symptom Onset of Non-ST-Segment Elevation Myocardial Infarction. JACC: Cardiovascular Interventions, v. 16, n. 1, p. 64–75, jan. 2023.
BARO, Rocío et al. High-sensitivity cardiac troponin T as a predictor of acute Total occlusion in patients with non-ST-segment elevation acute coronary syndrome. Clinical Cardiology, v. 42, n. 2, p. 222–226, fev. 2019.
BATUBARA, Edwin Adhi Darmawan et al. A case series of OMI: time for revisiting STEMI/NSTEMI ECG criteria. The Egyptian Heart Journal, v. 77, n. 1, p. 90, 30 set. 2025.
BONOW, R. O. et al. Heart disease. 9. ed. Philadelphia: Elsevier, 2012.
DE WINTER, Robbert J. et al. A New ECG Sign of Proximal LAD Occlusion. New England Journal of Medicine, v. 359, n. 19, p. 2071–2073, 6 nov. 2008.
FRICK, William H. et al. Occlusion myocardial infarction: a revolution in acute coronary syndrome. Advances in Interventional Cardiology, v. 21, n. 2, p. 139–143, 2025.
INSTITUTO DE MÉTRICAS E AVALIAÇÃO DA SAÚDE (IHME). Carga Global de
Doença 2021: Descobertas do Estudo GBD 2021. Seattle, WA: IHME, 2024.
KHAN, Abdur R. et al. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. European Heart Journal, v. 38, n. 41, p. 3082–3089, 1 nov. 2017.
KOLA, Martiola et al. OMI/NOMI: Time for a New Classification of Acute Myocardial Infarction. Journal of Clinical Medicine, v. 13, n. 17, p. 5201, 2 set. 2024.
KOS, Nikola et al. Impact of total occlusion of the infarct-related coronary artery on mortality of 2483 patients with acute myocardial infarction. World Journal of Cardiology, v. 18, n. 1, 26 jan. 2026.
MEYERS, Pendell; WEINGART, Scott; SMITH, Stephen. The OMI Manifesto. [S. l.]: Dr. Smith's ECG Blog; EMCrit, 2018. Disponível em: https://highlandpict.wordpress.com/wp-content/uploads/2023/12/the-omi-manifesto.pdf
MEYERS, H. Pendell et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. The Journal of Emergency Medicine, v. 60, n. 3, p. 273–284, mar. 2021.
MEYERS, H. Pendell et al. Failure of standard contemporary ST-elevation myocardial infarction electrocardiogram criteria to reliably identify acute occlusion of the left anterior descending coronary artery. European Heart Journal: Acute Cardiovascular Care, v. 14, n. 7, p. 403–411, 6 ago. 2025.
NASCIMENTO, K. et al. Síndrome Coronariana Aguda no Brasil: Registro dos Fatores Predisponentes e Perfil Populacional em um Instituto Cardiológico Público de Referência Nacional. Arquivos Brasileiros de Cardiologia, [s. l.], v. 122, n. 1, p. e20240165, 2025. https://doi.org/10.36660/abc.20240165.
RAO, S. V. et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Journal of the American College of Cardiology, [s. l.], , p. S073510972410424X, fev. 2025. https://doi.org/10.1016/j.jacc.2024.11.009.
RICCI, Fabrizio et al. ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review. Annals of Emergency Medicine, v. 85, n. 4, p. 330–340, abr. 2025.
