Ep 121: OMI/NOMI: A Paradigm Shift in Myocardial Infarction Diagnosis With Dr Stephen Smith

Average (ratings)

No ratings

•

Your rating

In this week's episode of Parallax, host Dr Ankur Kalra engages in a thought-provoking discussion with Dr Stephen Smith, a pioneer in electrocardiography and myocardial infarction diagnosis. They delve into the groundbreaking OMI/NOMI paradigm (Occlusion MI vs Non-Occlusion MI), challenging the traditional STEMI vs non-STEMI terminology that has long been the cornerstone of acute coronary syndrome management.

Dr Smith presents compelling evidence highlighting the limitations of ST-elevation as a marker for acute coronary occlusion, discussing his recently published review paper: "From ST-Segment Elevation MI to Occlusion MI: The New Paradigm Shift in Acute Myocardial Infarction".

The conversation explores the proposed shift to the OMI/NOMI terminology and the specific ECG criteria for diagnosing occlusion MI. Dr Smith discusses the challenges in disseminating this new paradigm and teaching these refined ECG interpretation skills to clinicians. Dr Kalra and Dr Smith explore exciting developments in AI-assisted OMI detection and ongoing studies aimed at validating the OMI/NOMI approach.

How can clinicians effectively implement the OMI/NOMI criteria into daily practice? What challenges exist in teaching these new ECG interpretation skills, and how can they be overcome? What advice does Dr Smith have for our listeners?

Sources:

McLaren J, et al. From ST-Segment Elevation MI to Occlusion MI: The New Paradigm Shift in Acute Myocardial Infarction. J Am Coll Cardiol Adv 2024;3:101314. DOI: 10.1016/j.jacadv.2024.101314.
Herman R, et al. Eur Heart J Digit Health 2023. International evaluation of an artificial intelligence–powered electrocardiogram model detecting acute coronary occlusion myocardial infarction. DOI: 10.1093/ehjdh/ztad010
Meyers HP, et al. IJC Heart & Vasculature 2021. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. DOI: 10.1016/j.ijcha.2021.100767
Meyers HP, et al. J Emerg Med 2021. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. DOI: 10.1016/j.jemermed.2020.10.026
Smith SW, Meyers HP. Ann Emerg Med 2023. Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined. DOI: 10.1016/j.annemergmed.2023.01.011
Meyers HP, et al. J Am Heart Assoc 2021. Ischemic ST‐Segment Depression Maximal in V1–V4 (Versus V5–V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). DOI: 10.1161/JAHA.121.022866
Bischof JE, et al. Am J Emerg Med 2016. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. DOI: 10.1016/j.ajem.2015.09.035
Smith SW, et al. Ann Emerg Med 2012. Diagnosis of ST Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block using the ST Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. DOI: 10.1016/j.annemergmed.2012.07.119
Meyers HP, et al. Am Heart J 2015. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. DOI: 10.1016/j.ahj.2015.09.005
Dodd KW, et al. Ann Emerg Med 2021. Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria. DOI: 10.1016/j.annemergmed.2021.03.036
de Alencar Neto JN, et al. Int J Cardiol 2024. Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion. DOI: 10.1016/j.ijcard.2024.131889
de Alencar JN, et al. Br Heart J 2024. No false negative paradox in STEMI-NSTEMI diagnosis. Available at: https://scholar.google.com/citations?view_op=view_citation&hl=en&citation_for_view=ZBKuiKwAAAAJ:9wUeeRLfbNYC
Koyama Y, et al. Am J Cardiol 2002. Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation. DOI: 10.1016/s0002-9149(02)02543-1
Khan AR, et al. Eur Heart J 2017. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis. DOI: 10.1093/eurheartj/ehx418
Hung C-S, et al. Crit Care 2018. Prevalence and outcome of patients with non-ST segment elevation myocardial infarction with occluded "culprit" artery - a systemic review and meta-analysis. DOI: 10.1186/s13054-018-1944-x
Mehta SR, et al. N Engl J Med 2009. Early versus delayed invasive intervention in acute coronary syndromes. DOI: 10.1056/NEJMoa0807986
Kofoed KF, et al. Circulation 2018. Correction to: Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome: VERDICT Randomized Controlled Trial. DOI: 10.1161/CIR.0000000000000640
Milosevic A, et al. J Am Coll Cardiol Cardiovasc Interv 2016. Immediate Versus Delayed Invasive Intervention for Non-STEMI Patients. DOI: 10.1016/j.jcin.2015.11.018
Lupu L, et al. Clin Cardiol 2022. Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients. DOI: 10.1002/clc.23781

Read MoreRead Less

Episodes

Up Next

Ep 122: Addressing Social Determinants of Cardiovascular Health

Ep 122: Beyond the Clinic: Addressing Social Determinants of Cardiovascular Health With Dr Karen Joynt Maddox

EP122 • Nov 14, 2024 • 46m 42s

In this thought-provoking episode of Parallax, Host, Dr Ankur Kalra engages in an illuminating conversation with Dr Karen Joynt Maddox, a distinguished cardiologist and health policy researcher at Washington University School of Medicine in St. Louis. Together, they navigate the complex intersection of cardiovascular medicine, health economics, and public health policy.

All Episodes

EP 62: Bullying, Harassment and Jealousy at Workplace with Dr Srihari S Naidu

EP62 • Jan 31, 2022 • 43m 38s

In this week's Parallax, Dr Ankur Kalra is joined by Dr Srihari S Naidu, Director of Cath Labs and Hypertrophic Cardiomyopathy Center at the Westchester Medical Center and President Elect of NY ACC, for an honest conversation on a challenging topic within the cardiology community.

EP 61: The Year 2021 in Review with Dr Sukh Nijjer — Top Trials in Heart Failure and Cardiac Surgery

EP61 • Jan 17, 2022 • 53m 30s

In the second part of Parallax’s review of 2021, Dr Sukh Nijjer, Interventional Cardiologist from Imperial College London, and Dr Ankur Kalra discuss key advances in the field of heart failure and cardiac surgery.

EP 60: The Year 2021 in Review with Dr Sukh Nijjer – Part 1

EP60 • Dec 27, 2021 • 59m 18s

In the last Parallax episode of the year, Dr Ankur Kalra welcomed back Dr Sukh Nijjer, Interventional Cardiologist from Imperial College London, to review the most impactful events and advances in cardiology from 2021.

Parallax AHA Edition: 3 Trials that will change your practice with Dr Amit Khera

EP59 • Dec 06, 2021 • 44m 29s

In this AHA 2021 episode of Parallax, Dr Ankur Kalra’s guest is Dr Amit Khera, Professor and Director of Preventive Cardiology at UT Southwestern Medical Center, Dallas and Vice Chair of the Scientific Sessions. For this week’s show, Dr Khera selected three thought-provoking late-breaking trials that will inform or change clinical practice.

Parallax TCT Edition: 3 Trials that will Change Your Practice with Prof Mamas Mamas

EP58 • Nov 15, 2021 • 47m 52s

In this TCT 2021 episode of Parallax, Dr Ankur Kalra’s guest is Prof Mamas Mamas, Consultant Interventional Cardiologist at University Hospitals of North Midlands NHS Trust (UHNM), Professor of Cardiology at Keele University and Senior Clinical Editor of TCTmd.

EP 57: Academic Success, Decision-making & Pragmatic Approach with Dr. Ambarish Pandey

EP57 • Nov 03, 2021 • 45m 52s

In celebration of Diwali, Dr. Ankur Kalra sat down with Dr. Ambarish Pandey, Assistant Professor at The University of Texas Southwestern Medical School, to talk about his career path and the questions that shaped his decision-making over the years.

Parallax HFSA Edition: Diversity, Equity, Inclusion & Belonging with Dr Nancy M. Albert

EP56 • Oct 11, 2021 • 44m 26s

This week’s Parallax in collaboration with the Heart Failure Society of America (HFSA) explores the many ways organisations can embrace the needs of a diverse community and create a culture that can react to the realities of patientcare.

EP 55: 5 Interventional trials that will change your practice: Review of ESC 21 with Dr Mirvat Alasnag

EP55 • Sep 28, 2021 • 53m 38s

In the second ESC 2021 episode of Parallax, Dr Ankur Kalra’s guest is Dr. Mirvat Alasnag, interventional Cardiologist and Director of Catheterization Laboratory at the King Fahad Armed Forces Hospital (KFAFH) in Saudi Arabia. Dr Alasnag was a programme committee member at this year’s ESC and regional PI of one of the late-breaking trials presented.

EP 54: 5 Trials that will change your practice: Review of ESC 21 with Dr Purvi Parwani

EP54 • Sep 06, 2021 • 1h

In this special ESC 2021 edition of Parallax, Ankur asks Purvi to review the highlights of the congress. Purvi summarises the design and findings of the trials and their importance in the treatment of patients. Ankur and Purvi discuss how the novel data presented at ESC will inform their practice.

EP 53: Belonging, Sparkplug & Purpose with Dr Nasrien E Ibrahim

EP53 • Aug 23, 2021 • 52m 54s

Dr Ankur Kalra’s guest is Dr Nasrien Ezzeldin Ibrahim, Director of Heart Failure Clinical Research at Inova Heart and Vascular Institute and the writer of SPARKPLUG: The Roadmap to Confidently Ignite and Navigate Your Career Without Compromising Your Dreams.
In this candid episode of Parallax, Nasrien and Ankur open up about their experiences of being an immigrant. Ankur asks Nasrien about her journey to medicine. Nasrien shares the lessons she took away from her years under the mentorship of Dr JoAnn Lindenfeld and later, Dr. James Januzzi. Finally, Nasrien shares her recent experience of writing Sparkplug and how she embraced life with its imperfections and found her purpose.

... 3 4 5 6 7 8 9 10 11 ...

... 6 7 8 ...

Ep 92: Beyond Metrics (Part 3): Redefining Success Through a Student-Centric Approach with Dr. Nandan Anavekar

Ep 92: 3/3 Beyond Metrics: Redefining Success Through a Student-Centric Approach with Dr Nandan Anavekar

EP92 • May 15, 2023 • 41m 36s

In this inspiring conversation, Dr Anavekar and Dr Kalra discuss the education of postgraduate medical students and reflect on Dr Anavekar’s role as a Program Director. Dr Anavekar shares his motivations and the moral framework he uses to approach his responsibility towards his students.

Ep 91: Beyond Metrics: Reimagining Success in Academic Medicine with Dr Anavekar

EP91 • May 02, 2023 • 45m 23s

In this stimulating and thought-provoking episode, Dr. Kalra and Dr. Anavekar delve into the topic of measuring success in medicine. Dr. Anavekar puts forward the argument that the ambiguous definition of academic achievement often results in damaging biases that have long-term repercussions on the medical field. As a program director, Dr. Anavekar believes that the number of published articles should not be the only or most crucial criterion for evaluating early-career faculty. He argues that it's important to also consider the "distance travelled" by candidates. Dr. Kalra raises pertinent questions about the practical implications of this approach, and Dr. Anavekar provides candid insights into his responsibilities.

Ep 90: Academic Bullying Unmasked: Enablers, Effects & Solutions with Dr Täuber & Dr Mahmoudi

EP90 • Apr 24, 2023 • 41m 31s

Dr Mahmoudi and Dr Täuber teamed up to explore bullying in academic settings. Together with Dr Kalra they discuss why bullies thrive in such environments and the ways institutions enable such behaviour. Dr Täuber offers solutions and a critical overview of institutional narratives, while Dr Mahmoudi highlights the long-term effects on academic work and medicine. They call for action against toxic behaviour and for stakeholders to eliminate incentives for universities to support perpetrators.

Ep 89: Contemplative Self-Exploration & Outcome-Focused Cardiology with Dr Nandan Anavekar

EP89 • Apr 05, 2023 • 44m 54s

In 2018, the loss of a friend to suicide compelled Dr Anavekar to embark on a profound journey of contemplative self-exploration. Now, he uses his experience to encourage and guide trainees to pose thought-provoking questions that challenge the status quo of the materialistic approach to medicine, ultimately leading to a more outcome-focused perspective.
What is the Global Cardiology University project? How does Dr Anavekar encourage trainees to re-examine their role in patient care? What is his advice to our listeners?

Ep 88: Leadership, Advocacy & Involvement in Your Local ACC Chapter with Dr Vijay Rao

EP88 • Mar 21, 2023 • 44m 19s

In the latest episode of Parallax, Dr. Ankur Kalra invites Dr Vijay Rao, the Governor of the Indiana Chapter of the American College of Cardiology, to share his experience and insights with the audience.
As Dr Kalra asks Dr Rao about the ways in which early career faculty members can get involved with the organization at a state level. Dr Rao shares his insider tips and highlights key events where individuals can further their participation.
How can you get involved with your local ACC chapter? How can you improve your leadership skills? What is Dr Rao’s advice for our listeners?

... 5 6 7 8 9 10 ...

... 6 7 8 ...