Occlusion myocardial infarction: a revolution in acutecoronary syndrome

The 2025 ACC Guideline for the Management of Patients With Acute Coronary Syndromes claims that “Patients with NSTEMI may have a partially occluded coronary artery leading to subendocardial ischemia, while those with STEMI typically have a completely occluded vessel leading to transmural myocardial ischemia and infarction.” This is accompanied by a visual representation of a partially occlusive thrombus labeled ‘NSTEMI’ above an electrocardiogram (ECG) showing ST depression and T wave inversion, and a completely occlusive thrombus labeled ‘STEMI’ above an ECG showing ST elevation. This paradigm has remained despite two decades of angiographic and evidence-based ECG advances, which highlight the multiple reasons why a revolution in acute coronary syndrome (ACS) is needed, and has begun.

This study aimed to measure physician accuracy for interpreting STEMI-equivalent and STEMI-mimic ECGs for catheterization laboratory activation (CLA) and compare their performance to a machine learning-based artificial intelligence algorithm, Queen of Hearts AI (QoH AI).