{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T11:04:19Z","timestamp":1793876659155,"version":"4.7.0"},"reference-count":5,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Guidelines recommend immediate invasive management for non\u2013ST-segment elevation acute coronary syndrome (NSTE-ACS) patients meeting very high-risk (VHR) criteria. Whether these criteria identify occlusion myocardial infarction (OMI) and expedite reperfusion is uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This post-hoc analysis included 2979 NSTE-ACS patients undergoing percutaneous coronary intervention (PCI) in the MATRIX programme with available culprit-lesion flow. OMI was defined as culprit-vessel TIMI flow 0\u20131. We evaluated European Society of Cardiology (ESC) and American College of Cardiology\/American Heart Association (ACC\/AHA) VHR criteria for OMI detection and time from first medical contact (FMC) to PCI. OMI occurred in 592 patients (19.9%). At least one VHR criterion was present in 52.9% according to ESC and 14.1% according to ACC\/AHA definitions. Among patients with OMI, only 58.1% fulfilled ESC and 24.1% ACC\/AHA criteria. Median FMC-to-PCI time was shorter in patients fulfilling ESC criteria (27.0 vs. 40.5 h) or ACC\/AHA VHR criteria (12.2 vs. 69.9 h; both P &amp;lt; 0.001). Nevertheless, PCI within 2 h occurred in only 2.6% and 7.7% of patients meeting ESC and ACC\/AHA criteria, respectively, and in 3.6% of patients with OMI. Even among OMI patients fulfilling VHR criteria, timely reperfusion within 2 h occurred only 4.7% and 9.9%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Guideline-directed VHR criteria had limited sensitivity for OMI and rarely translated into guideline-recommended immediate PCI. Current NSTE-ACS classification and triage strategies require reconsideration to improve recognition and timely reperfusion of acute coronary occlusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjacc\/zuag096","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T11:11:49Z","timestamp":1785323509000},"source":"Crossref","is-referenced-by-count":1,"title":["Impact of guidelines-directed very-high-risk criteria in the identification and management of occlusion myocardial infarction in patients with NSTE-ACS"],"prefix":"10.1093","author":[{"given":"Andrea","family":"Milzi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) , Via Tesserete 48, 6900 Lugano ,","place":["Switzerland"]},{"name":"Faculty of Biomedical Sciences, Universit\u00e1 della Svizzera Italiana , Lugano ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-1083","authenticated-orcid":false,"given":"Antonio","family":"Landi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) , Via Tesserete 48, 6900 Lugano ,","place":["Switzerland"]},{"name":"Faculty of Biomedical Sciences, Universit\u00e1 della Svizzera Italiana , Lugano ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4800-6132","authenticated-orcid":false,"given":"Sergio","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Pavia and Fondazione IRCCS Policlinico San Matteo , Pavia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6543-7567","authenticated-orcid":false,"given":"Marco","family":"Frazzetto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) , Via Tesserete 48, 6900 Lugano ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3587-1458","authenticated-orcid":false,"given":"Marco","family":"Covani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) , Via Tesserete 48, 6900 Lugano ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Frigoli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) , Via Tesserete 48, 6900 Lugano ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2344-7564","authenticated-orcid":false,"given":"Arnoud W J","family":"Vant\u2019Hof","sequence":"additional","affiliation":[{"name":"Maastricht University Medical Center (MUMC) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1526-0652","authenticated-orcid":false,"given":"Pascal","family":"Vranckx","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis , Hasselt ,","place":["Belgium"]},{"name":"Faculty of Medicine and Life Sciences, University of Hasselt , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4353-7110","authenticated-orcid":false,"given":"Marco","family":"Valgimigli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC) , Via Tesserete 48, 6900 Lugano ,","place":["Switzerland"]},{"name":"Faculty of Biomedical Sciences, Universit\u00e1 della Svizzera Italiana , Lugano ,","place":["Switzerland"]},{"name":"Faculty of Medicine, University of Bern , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"2026081823320978500_zuag096-B1","doi-asserted-by":"crossref","first-page":"3720","DOI":"10.1093\/eurheartj\/ehad191","article-title":"2023 ESC guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"Eur Heart J"},{"key":"2026081823320978500_zuag096-B2","doi-asserted-by":"crossref","first-page":"3082","DOI":"10.1093\/eurheartj\/ehx418","article-title":"Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis","volume":"38","author":"Khan","year":"2017","journal-title":"Eur Heart J"},{"key":"2026081823320978500_zuag096-B3","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1016\/j.jacc.2024.11.009","article-title":"2025 ACC\/AHA\/ACEP\/NAEMSP\/SCAI guideline for the management of patients with acute coronary syndromes: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"85","author":"Rao","year":"2025","journal-title":"J Am Coll Cardiol"},{"key":"2026081823320978500_zuag096-B4","doi-asserted-by":"crossref","first-page":"2465","DOI":"10.1016\/S0140-6736(15)60292-6","article-title":"Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial","volume":"385","author":"Valgimigli","year":"2015","journal-title":"Lancet"},{"key":"2026081823320978500_zuag096-B5","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1056\/NEJMoa1507854","article-title":"Bivalirudin or unfractionated heparin in acute coronary syndromes","volume":"373","author":"Valgimigli","year":"2015","journal-title":"N Engl J Med"}],"container-title":["European Heart Journal: Acute Cardiovascular 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