Acute Inferior Myocardial Infarction: Beyond the ST-Segment Elevation

Authors

  • Diana Rocha Internal Medicine Department, Matosinhos Local Health Unit , Matosinhos, Portugal https://orcid.org/0000-0002-1284-2294
  • Pedro Simões Internal Medicine Department , Nordeste Local Health Unit, Bragança Hospital Unit Bragança, Portugal
  • João Gouveia Internal Medicine Department, Central Hospital of Funchal, Funchal, Madeira, Portugal
  • Cátia Ferreira Department of Cardiology, Heart Failure Unit, Coimbra University Hospital, Coimbra, Portugal
  • Fátima Franco 4Department of Cardiology, Heart Failure Unit, Coimbra University Hospital, Coimbra, Portugal

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https://doi.org/10.60591/crspmi.173

Keywords:

Electrocardiography, Inferior Wall Myocardial Infarction

Abstract

Acute coronary syndromes (ACS) are considered a continuum, enclosing both non-ST-elevation (NSTE)-ACS, including unstable angina and non-ST-elevation myocardial
infarction (NSTEMI), and ST-elevation myocardial infarction
(STEMI). The diagnosis of myocardial infarction (MI) is
associated with troponin release. Classification of MI has
fundamentally been based on the presence or absence of ST-segment elevation (STE) on the electrocardiogram (ECG). STE is a poor surrogate for acute coronary occlusion (ACO) causing MI. Mounting evidence suggests that a substantial fraction of patients presenting with NSTEMI have an ACO of their culprit artery. Due to a lack of classic ECG findings, these NSTEMI patients, despite ACO of the culprit artery, may be missed, leading to either delay in or no revascularization. This case report highlights one specific pattern potentially identifying ACO that does not meet STEMI criteria, the Aslanger pattern. Early identification of this NSTEMI pattern potentially accelerates revascularization.

References

Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023, 12;44:3720-826. doi: 10.1093/eurheartj/ehad191

Sankardas MA, Ramakumar V, Farooqui FA. Of Occlusions, Inclusions, and Exclusions: Time to Reclassify Infarctions? Circulation. 2021, 144:333-5. doi: 10.1161/CIRCULATIONAHA.121.055827

Khan AR, Golwala H, Tripathi A. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. Eur Heart J. 2017;38:3082-89. doi: 10.1093/eurheartj/ ehx418.

Tziakas D, Chalikias G, Al-Lamee R, Kaski RC. Total coronary occlusion in non ST elevation myocardial infarction: Time to change our practice? Int J Cardiol. 2021; 329:1–8. doi: 10.1016/j.ijcard.2020.12.082

Meyers HP, Bracey A, Lee D, Lichtenheld A, Li WJ, Singer DD, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of

acute coronary occlusion myocardial infarction. Int J Cardiol Heart Vasc. 2021;33:100767. doi: 10.1016/j.ijcha.2021.100767

Aslanger EK, Meyers PH 2, Smith SW: STEMI. A transitional fossil in MI classification? J Electrocardiol. 2021;65:163-9. doi: 10.1016/j.jelectrocard.2021.02.001.

Aslanger EK, Meyers HP, Bracey A, Smith SW. The STEMI/NonSTEMI Dichotomy needs to be replaced by Occlusion MI vs. Non-Occlusion MI. Int J Cardiol. 2021;330:15. doi: 10.1016/j.ijcard.2021.02.015

Meyers HP, Bracey A, Lee D, Lichtenheld A, Li WJ, Singer DD, et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. J Emerg Med. 2021;60:273-84. doi: 10.1016/j.jemermed.2020.10.026.

Aslanger EK, Yıldırımtürk O, Simsek B, Bozbeyoglu E, Simsek MA, Yücel Karabay C, et al. DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction (DIFOCCULT Study). Int J Cardiol Heart Vasc. 2020;30:100603. doi: 10.1016/j.ijcha.2020.100603.

Aslanger EK, Meyers HP, Smith SW. Time for a new paradigm shift in myocardial infarction. Anatol J Cardiol. 2021;25:156-62. doi: 10.5152/Anatol-JCardiol.2021.89304.

Aslanger E, Yıldırımtürk O, Simsek B, Sungur A, Türer Cabbar A, Bozbeyoglu E, et al. A new electrocardiographic pattern indicating inferior myocardial infarction. J Electrocardiol. 2020;61:41-6. doi: 0.1016/j.jelectrocard.2020.04.008.

Koyama Y, Hansen PS, Hanratty CG, Nelson GIC, Rasmussen HH. Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation. Am J Cardiol. 2002;90:579-84. doi: 10.1016/s0002-9149(02)02559-6.

Miyauchi E, Kuwazuru K, Arikawa R, Tokutake D, Chaen H, Oketani N, Ohishi M. Clinical Features of the Aslanger Pattern to Compensate for the Limitation of ST-Elevation Myocardial Infarction (STEMI) Criteria. Cureus. 2023;15:e33227. doi:m10.7759/cureus.33227.

Al-Zaiti SS, Martin-Gill C, Zègre-Hemsey JK, Bouzid Z, Faramand Z, Alrawashdeh MO, et al. Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction. Nature Med. 2023;29:1804–13. doi: 10.1038/s41591-023-02396-3.

Sanchis J, Núñez E, Barrabés JÁ. Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. Eur J Intern Med. 2016;35:89-94. doi: 10.1016/j.ejim.2016.07.003.

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Published

2024-06-24

How to Cite

Rocha, D., Simões, P., Gouveia, J., Ferreira, C., & Franco, F. (2024). Acute Inferior Myocardial Infarction: Beyond the ST-Segment Elevation. SPMI Case Reports, 2(Edição Especial), 36–39. https://doi.org/10.60591/crspmi.173

Issue

Vol. 2 No. Edição Especial (2024): Abril/Junho

Section

Casos Clínicos

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Copyright (c) 2024 Diana Rocha, Pedro Simões, João Gouveia, Cátia Ferreira, Fátima Franco

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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