{"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":1793876659565,"version":"4.7.0"},"reference-count":88,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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:p>The electrocardiogram (ECG) is the only rapid, non-invasive diagnostic test that can identify coronary occlusion warranting reperfusion therapy at the bedside. The diagnostic paradigm of ST-segment elevation (STE) myocardial infarction (STEMI)\/non-STEMI (NSTEMI) is based on millimetre STE criteria as stated in the 4th Universal Definition of MI. It has identified candidates for emergent reperfusion for decades, but is limited by the low sensitivity and specificity of STE for acute coronary occlusion. A paradigm shift to occlusion MI\/non-occlusion MI (OMI\/NOMI) has been proposed in response. Although the ECG is not embedded in the OMI\/NOMI nomenclature as it is in STEMI\/NSTEMI, it remains critical to the initial diagnosis of OMI. This review outlines six principles\u2014dynamicity, acuteness, reciprocity, proportionality, totality, and surrogacy\u2014that organize expert interpretation of the ischaemic ECG and are essential to the ECG diagnosis of OMI. Each is drawn from established scholarship; the contribution here is their integration into one framework linked to coronary pathology.<\/jats:p>","DOI":"10.1093\/ehjacc\/zuag114","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:33:28Z","timestamp":1788446008000},"source":"Crossref","is-referenced-by-count":1,"title":["Electrocardiographic principles for the diagnosis of occlusion myocardial infarction"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3282-9504","authenticated-orcid":false,"given":"Hans C","family":"Helseth","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Medical College of Wisconsin , Milwaukee, WI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0065-9715","authenticated-orcid":false,"given":"Pedro","family":"Mansur","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"El-Baba","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, University of Toronto , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6310-4988","authenticated-orcid":false,"given":"Jesse T T","family":"McLaren","sequence":"additional","affiliation":[{"name":"Emergency Department, University Health Network , Toronto ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3835-6067","authenticated-orcid":false,"given":"Jos\u00e9 Nunes","family":"de Alencar","sequence":"additional","affiliation":[{"name":"Electrocardiography Unit, Instituto Dante Pazzanese de Cardiologia , Avenida Dr. Dante Pazzanese No. 500, Vila Mariana, S\u00e3o Paulo 04012-091 ,","place":["Brazil"]},{"name":"Research Division, Instituto Dante Pazzanese de Cardiologia , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9166-9804","authenticated-orcid":false,"given":"Stephen W","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Hennepin Healthcare and the University of Minnesota , Minneapolis, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"2026090801463374000_zuag114-B1","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jelectrocard.2004.08.032","article-title":"Modification of ACC\/ESC criteria for acute myocardial infarction","volume":"37 Suppl","author":"Macfarlane","year":"2004","journal-title":"J 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