Pendell Meyers is attempting to change the paradigm of classifying MIs as STEMI vs. NSTEMI. An important first step in this attempt was his publishing the
OMI Manifesto
Ideas to Think About…
- False Negative Paradox
- Why did the term stemi equivalents not catch on?
- Why is there not currently a retrospective coding of missed occlusive MIs?
Please, please put your thoughts and comments below
Updates
- Literature proving STEMI sucks
- OMI Quality Study [https://doi.org/10.1016/j.ajem.2023.08.022]
Additional New Information
More on EMCrit
EMCrit Podcast 42: A phD in EKG with Steve Smith(Opens in a new browser tab)
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Dr Meyers,
I wholeheartedly agree with your manifesto. I feel like a lot of headway could be made already if the indication for emergent cath in refractory ischemia was more well known to cardiologists though.
Can I ask why you chose OMI instead of ACO (acute coronary occlusion)? It is to me that the occluded LAD that is stented before troponins rise, should be included.
Best regards,
Maarten Van Hemelen
ID/CC resident
Great question. Ultimately its really just a nomenclature discussion regarding ACO. Yes, ACO is the anatomic event that causes OMI. We wanted OMI to encompass more than just the anatomic event, but also the pathophysiologic event which occurs to the patient, as well as wanting the nomenclature to be relatable to the current STEMI vs. NSTEMI paradigm. You’ll notice we’ve been using ACO as the angiographic outcome term for years in our studies, like in our LBBB validation study. So they are both important terms to me, and I think they both have meaning. In the best case scenario, you… Read more »
This is brilliant! Not to days after reviewing this we had a patient with non-stand me non stemi Designation that was getting a Kath early only due to complete AV block.
The EKG was suggestive of posterior wall and then with hyperacute T waves.
The catheter showed Multivessel CAD with complete occlusion of RCA and left Main.
Now this person is on IABP and Temp TV paced.
EF was 30%
Truly Jedi stuff!
Thanks!
Dr Meyers,
Thank you! I am definitely a convert. You’ve given me the vocabulary to explain the highly suspicious ECG that doesn’t fit our current criteria.
As a paramedic I can pre-alert for PCI but only for the current STEMI criteria. I can transmit the non-criteria highly suspicious ECG’s but it’s hit or miss whether the receiving hospitals will activate.. Your manifesto gives me the quantitative and qualitative knowledge to “punch up” a report so it may be given more urgency!
Thanks, Mike! good to hear
Thanks for this video
This kind of research and education is incredibly important when you have to talk with a cardiologist who has never even heard of a STEMI-equivalent… Sadly, even in 2019, most clinicians in my country (southern France) do not speak English and therefore do not have access to this knowledge
Keep up the good work
Thanks for your comment!
We have had the OMI manifesto translated into several languages including Spanish, German, and Dutch so far. Hopefully more to come.
This lecture wasn’t outstanding not only in the points that it makes regarding the STEMI paradigm, but also in the excellent occlusive-evidence-on-EKG lesson that is rolled in with it.
I’m sure I’m not the first person to point this out, but a barrier to OMI catching on is that “I think this patient has ‘an OMI’” and “I think this patient has ‘a NOMI’” sound almost exactly the same, just because of the way we say ‘a’ versus ‘an’ in English based on vowels. Say that over the phone to a consultant five times fast.
Pardon my typo: this lecture WAS outstanding!
Thanks for your comment Ryan. Glad you liked it. The sound problem you point out may be a potential barrier, but there are certainly ways around it. I advocate saying the word “occlusion” in full, because it gives everyone in the situation mental permission to think about the actual pathology and whether there’s truly an occlusion (this is not mentally allowed in the STEMI paradigm). So you can simply say, “I think the patient has an occlusion MI”. Or you could drop the article: I think they have OMI. I think they have NOMI. Multiple way to fix it, but… Read more »