Towards a New Classification of MI (This Week in Cardiology, by Dr. John Mandrola)
In this This Week in Cardiology episode, Dr. John Mandrola reviews a landmark paper calling for a shift from the STEMI/NSTEMI paradigm to Occlusion MI (OMI) vs non-OMI. The new framework highlights missed occlusions, challenges outdated classifications, and emphasizes AI and advanced ECG skills to improve early diagnosis and patient outcomes.
About the Podcast
This Week in Cardiology is hosted by Dr. John Mandrola, a practicing cardiologist and writer, known for sharp insights into clinical research and evolving paradigms in cardiovascular medicine. The podcast highlights evidence that challenges long-held dogma and impacts real-world care.
Summary of the Episode
In this episode, Dr. Mandrola reviews a JACC Advances state-of-the-art paper questioning the long-standing STEMI/NSTEMI classification and proposing a shift to Occlusion MI (OMI) vs non-OMI.
- Roughly half of patients with acutely occluded coronary arteries do not show ST elevation on ECG.
- Nearly 1 in 3 NSTEMI patients actually have an occlusion and could benefit from emergent PCI.
- The current paradigm hides false negatives — patients with occlusion but without ST elevation are mislabeled as NSTEMI, delaying life-saving treatment.
- Authors propose four steps:
- Change the language to OMI vs non-OMI.
- Update the medical record to reflect OMI vs non-OMI.
- Transition “code STEMI” to “code OMI.”
- Improve early diagnosis in prehospital and ED settings using AI, ECG expertise, and point-of-care ultrasound.
- Dr. Mandrola stresses that AI tools like PMcardio Queen of Hearts™ and better ECG education can help identify subtle occlusions often missed under the old paradigm.
“This may be the most important topic I’ve covered in a long time: OMI, not STEMI or NSTEMI. It’s time for a Kuhn-like scientific revolution.”— Dr. John Mandrola, This Week in Cardiology
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About PMcardio
PMcardio is a CE-marked Class IIb AI medical device that interprets any 12-lead ECG — from a photo or a digital file — in seconds. It detects 50+ ECG findings, including occlusion myocardial infarction (OMI) — the acute coronary occlusions that conventional STEMI criteria miss in over half of cases. Its Queen of Hearts™ OMI model holds FDA Breakthrough Device Designation, and PMcardio is already used by 100,000+ clinicians who have analyzed more than 2.5 million ECGs.
About Powerful Medical
Powerful Medical is a medical-technology company using artificial intelligence to transform how cardiovascular disease — the world’s leading cause of death — is diagnosed. Founded in 2017, it built PMcardio, the world’s first AI medical device to detect acute coronary occlusion (OMI) from an ECG. Its research is published in the European Heart Journal – Digital Health and validated across 25+ clinical studies, and its Queen of Hearts™ model earned FDA Breakthrough Device Designation. To date, PMcardio has supported the detection of 120,000+ heart attacks across 150+ hospital deployments worldwide.
