Of Occlusions, Inclusions, and Exclusions: Time to Reclassify Infarctions?
Mullasari Ajit Sankardas, Venkatakrishnan Ramakumar, Faraz Ahmed Farooqui
Abstract
lassification of myocardial infarction (MI) has hitherto been on the basis of the presence or absence of ST-segment-elevation on the ECG. The landmark FTT (Fibrinolytic Therapy Trialists') collaborative group meta-analysis and the subsequent study of patient subpopulations revealed that the largest benefit of immediate reperfusion therapy was in individuals with ST-segment-elevation MI (STEMI) with a tendency toward net harm in patients who had either ST depression or a normal ST-segment on their ECG. 1 Apart from being on the basis of extensive clinical trial data, the classification also had the advantages of practical application. Patients with STEMI can be quickly identified by bedside ECG and often have complete angiographic occlusion of a culprit vessel. Although this has remained the standard for decades, ST-segment-elevation may not encompass the entire population of patients with acute MI with occlusion or who may benefit from emergent revascularization.