Retrospective comparison of occlusion (OMI) and non- occlusion myocardial infarction (NOMI) paradigms in patients diagnosed with Stemi and Nstemi in the emergency department

Objective: We investigated the OMI/NOMI paradigm in the diagnosis and treatment of patients with total or near-total occluded coronary artery lesions diagnosed with acute myocardial infarction in the emergency department. Materials and Methods: Patients who applied to Bolu Abant İzzet Baysal University Hospital Emergency Service, were diagnosed with STEMI and NSTEMI between 01.12.2021 and 31.10.2023, underwent coronary angiography, and had complete data were included in the study. Retrospective OMI diagnosis in patients diagnosed with STEMI (+) and STEMI (-) according to previous studies, an acute culprit lesion in the coronary artery with TIMI 0-2 flow confirmed on CAG, coronary occlusion >70% and excessively increased hscTn-I patients with a diagnosis of NOMI were classified as not meeting the diagnosis of OMI. Results:1052 patients were included in our study. The STEMI/NSTEMI paradigm could not detect ACO in 51.4% of the patients (n=430), in other words, 51.4% of the patients diagnosed with OMI did not meet the STEMI criteria. In our study, the STEMI(+)OMI group had the highest probability of being subjected to coronary angiography within <2 hours (72.6%), and the STEMI(-)OMI group had the highest probability of being subjected to coronary angiography after >2 hours (63.6%). group (p<0.001). The rate of patients in the STEMI(+) group undergoing CAG before 2 hours was found to be significantly higher (81.5%) (p<0.001). In STEMI(- ) group patients, the rate of undergoing CAG after 2 hours was found to be significantly higher (88.4%)(p<0,001). Conclusion: The OMI/NOMI paradigm detects acute coronary occlusion better than the STEMI/NSTEMI paradigm. Our study shows that the OMI/NOMI paradigm can improve treatment and clinical outcomes in patients with acute coronary syndrome.