Powerful Medical Receives €40 Million IPCEI Grant — read the full story

Powerful Medical
24. March 2026
3 min to read

Detecting Occlusion Myocardial Infarction with an AI-Powered ECG Model: A Retrospective Cohort Study

Overview

This study investigates the clinical utility of personalized medicine approaches in a specific disease context, focusing on identifying relevant biomarkers, patient characteristics, and tailored management strategies. The authors highlight how integrating clinical, molecular, and patient-specific data can improve diagnosis, risk stratification, and treatment selection, while also addressing current limitations such as heterogeneity of evidence and challenges in implementation. Overall, the findings emphasize the growing role of precision medicine in optimizing outcomes and supporting more individualized, data-driven clinical decision-making.

Published in: Journal of Personalized Medicine
Published on: 24 March 2026

Background

Patients with NSTEMI who are found with a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Artificial intelligence (AI) models can help identify this subgroup of NSTEMIs. 

Methods

In this retrospective cohort study, 12-lead ECGs corresponding to patients with suspected OMI were analyzed by an AI model. Confirmation of OMI was based on angiographic evidence of acute culprit coronary artery stenosis. 

Results

Over a one-year period, emergency physicians at our hospital identified 474 patients with suspected OMI, of whom 88 met STEMI criteria. Out of the 142 angiographically confirmed OMIs, the AI model correctly identified 115 (81%) with high confidence, corresponding to an accuracy of 89.4%, sensitivity of 90.0%, specificity of 93.2%, positive predictive value (PPV) of 84.6%, and negative predictive value (NPV) of 91.4%. Out of the 74 angiographically confirmed OMIs that did not meet STEMI criteria, the AI model correctly identified 49 (66%) with high confidence, corresponding to an accuracy of 87.9%, sensitivity of 66.2%, specificity of 93.4%, PPV of 72.1%, and NPV of 91.5%. Out of the 68 angiographically confirmed OMIs that met STEMI criteria, the AI model correctly identified 66 (97%) with high confidence, corresponding to an accuracy of 95.5%, sensitivity of 97.1%, specificity of 90.0%, PPV of 97.1%, and NPV of 90.0%. Conclusions: The AI model examined in this study outperformed the STEMI criteria for the identification of OMI with respect to accuracy, sensitivity, specificity, PPV, and NPV and accurately identified a significant portion of NSTEMIs found to have total thrombotic coronary artery occlusion.

Conclusion

The AI model examined in this study outperformed the STEMI criteria for the identification of OMI with respect to accuracy, sensitivity, specificity, PPV, and NPV and accurately identified a significant portion of NSTEMIs found to have total thrombotic coronary artery occlusion.

Detecting Occlusion Myocardial Infarction with an AI-Powered ECG Model: A Retrospective Cohort Study
Authors: Mark B. Hellerman, Cassie Wang, David T. Zhang, Andreas P. Kalogeropoulos and Hal A. Skopicki

Author-Logo_PM
Powerful Medical leads one of the most important shifts in modern medicine by augmenting human-made clinical decisions with artificial intelligence. Our primary focus is on cardiovascular diseases, the world’s leading cause of death.

About PMcardio

PMcardio is a CE-certified AI that reads ECGs and offers a complex assessment of 49 cardiac conditions. Clinically validated in 15+ studies and trusted by over 100,000 clinicians, it delivers rapid, expert‑level interpretations, empowering emergency physicians, GPs, nurses, paramedics, and cardiologists to act with confidence at the point of care. Available for Individuals and Organizations.

About Powerful Medical

Established in 2017, Powerful Medical has embarked on a mission to revolutionize the diagnosis and treatment of cardiovascular diseases. We are a medical company backed by 28 world-class cardiologists and led by our expert Scientific Board with decades of experience in daily patient care, clinical research, and medical devices. The results of our research are implemented, developed, certified, and brought to market by our 50+ strong interdisciplinary team of physicians, data scientists, AI experts, software engineers, regulatory specialists, and commercial teams.

Share this article

Relevant Publications

Can an AI ECG algorithm improve diagnostic accuracy for acute coronary occlusion in the difficult subset of canceled catheterization lab activations?

Discordance in ECG interpretation between Emergency Medicine and Cardiology teams is common, and within canceled STEMI activations, a true acute coronary occlusion myocardial infarction (OMI) can go unrecognized. This retrospective study examined whether an AI ECG algorithm (Queen of Hearts™) could improve OMI detection in this difficult subset. Across three referral centers, the investigators analyzed 185 activations canceled for not meeting STEMI criteria, of which 17 met the definition of a missed OMI. The AI algorithm identified 16 of 17 cases, far exceeding STEMI criteria in sensitivity (94.1% vs. 47.1%), supporting its use as an adjunct to clinical judgment in ambiguous cases.

Artificial Intelligence-Assisted, ECG-Based Triage of Patients With Chest Pain to Immediate Invasive Treatment

Rapid identification of acute coronary occlusion (ACO) is critical in chest pain patients, yet conventional STEMI criteria miss occlusion in many NSTEMI cases, delaying life-saving invasive treatment. This retrospective study tested whether a deep learning ECG AI model could improve ACO detection in an unselected cohort of more than 4,000 consecutive patients from a German chest pain unit. Each 12-lead ECG was assessed using both standard STEMI criteria and the AI model, with ACO independently adjudicated by a blinded physician. The AI model clearly outperformed STEMI criteria, identifying 73 of 104 ACO cases versus 30 (area under the curve 0.958 vs. 0.589), with fewer false positives. The findings suggest AI-assisted ECG interpretation can detect subtle ischemic changes beyond established criteria and support faster triage of NSTE-ACO patients to immediate invasive care.

Join over 100,000 healthcare professionals who are already taking advantage of AI