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
After the #MedBikini campaign provoked by a misogynistic study that scrutinized female doctors’ social media posts, this episode is about creating a safer environment for female healthcare professionals.
The charity organisation, Women as One is an agent for women and men to be part of medicine that is built on talent, rather than a privilege. Roxana and Ankur discuss the role of mentorship and family-friendly work environment in mending the broken house of cardiology. Roxana talks about the practical tools that are available for women to take the next steps in their career and achieve their goals.
Dr Kalra asks Dr Mauri about early influences and her traineeship with legendary interventionalists, the late Donald Baim and Richard Kuntz. Dr Mauri talks openly about her decision-making process and the importance of selecting your priorities and committing to them. Ankur asks Laura about her decision to go into industry. Laura shares her thoughts on medical innovations and meeting urgent needs with unique perspectives.
What is Dr Mauri’s advice for a young cardiologist? How did she balance research and patient care? What are the questions that helped her decision making? How does Dr Mauri think about innovations in medicine?
Brigham and Women’s Hospital’s Health Equity Committee decided to confront the status quo by asking: How is racism on a structural level present within our walls?
Ankur Kalra’s guests Michelle Morse (Founding Co-Director of EqualHealth and Assistant Professor at Harvard Medical School) and Lauren Eberly (Cardiology Fellow at the University of Pennsylvania) are co-authors of a retrospective study that demonstrated what had previously only been observed: That black or brown heart failure patients ended up in general medicine rather than specialised cardiology services. Following the publication of the study in November 2019, the Health Equity Committee started to roll out anti-racism trainings and to work on objective admission guidelines to mitigate biased behaviours.
Aarti Bhatt (Assistant Professor of Medicine at the University of Minnesota), member of the Minnesota chapter of Campaign Against Racism, talks about their initiative to support projects that have a positive impact on local communities on a global scale.
In this week’s Parallax, Dr Kanaa’N, the director of the program, and Dr Lahorra, chairman of the Heart, Vascular & Thoracic Department of Akron General introduce the listeners to the foundations of their program and the paradigm shift brought by TAVR.
Ankur Kalra asks Grant W Reed, Director of the Cleveland Clinic’s STEMI program, to reflect on the actions they took and the challenges of delaying cardiovascular procedures in the wake of the coronavirus pandemic. Dr Reed offers insight on the factors that influenced the Cleveland Clinic’s STEMI policy for COVID-19. Ankur and Grant discuss the triage considerations for patients with structural heart disease and the steps the clinic took to protect its healthcare workers.
In this edition of Parallax Dr Kalra asked Dr Rosenbaum about the influences that shaped her choices as a writer and as a healthcare professional. Dr Rosenbaum opens up about her childhood and how she connected to her grandfather through writing and medicine. We learn about Lisa’s first day at medical school and her latest writing project.
Jagmeet P Singh, associate chief of the cardiology division at Massachusetts General Hospital and professor of medicine at Harvard Medical School joins Ankur Kalra for a deep conversation about his journey across three continents. Dr Singh talks about the importance of choosing fulfilment over success. We gain more insights on the recent late-breaking trial, MADIT-CHIC focusing on cardiac resynchronization therapy. Ankur asks Jag about his experience of being on the other side of the healthcare system and his enrolment in the since halted remdesivir trial.
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Hear them discuss the burden on healthcare, patient selection, the importance of testing and PPE and how COVID has resulted in a reduction of acute myocardial infarction and heart failure in patients.
In this latest episode, Ankur Kalra, MD meets with Andrew Sauer, MD, co-author of an upcoming paper in US Cardiology Review on COVID-19 and Cardiovascular Disease that provides a concise and current summary of cardiovascular complications from COVID-19.
Hear them discuss the latest issues surrounding the pandemic, the known cardiac implications and the rapidly emerging data.
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.