{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T11:19:45Z","timestamp":1787743185836,"version":"build-2784847793"},"reference-count":69,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Approximately one\u2010quarter to one\u2010third of patients with non\u2010ST\u2010elevation myocardial infarction have a completely occluded culprit coronary artery but are not routinely referred for emergent reperfusion. A growing literature describes electrocardiographic patterns purported to identify acute coronary occlusion (ACO) in non\u2010STEMI populations, but guideline adoption has been limited and inconsistent. We conducted a scoping review to map the extent, characteristics, and methodologies of primary studies examining non\u2010ST\u2010elevation ECG patterns against reference standards for ACO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Electronic databases were searched and supplemented by backward and forward citation tracking. Primary studies were included evaluating non\u2010ST\u2010elevation ECG patterns against an angiographic or composite reference standard for ACO. Studies using stenosis severity or anatomical disease burden as the reference standard were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty\u2010two studies were included, yielding 78 pattern\u2010level data sources spanning 20 ECG patterns. Only 23\/78 data sources evaluated undifferentiated ACS patients. Measurable index test definitions were present in 33\/78 data sources. Reference standards were highly heterogeneous. Although 70\/78 data sources defined a reference standard for ACO, only 29\/78 reported diagnostic test accuracy values, most of which were in the LBBB\/VPR category.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The literature is heterogeneous, methodologically uneven, and concentrated in a small number of pattern categories. Outside the LBBB\/VPR criteria, diagnostic test accuracy data in NSTE\u2010ACS populations are sparse, and methodological features that critically affect their interpretation are inconsistently reported. These findings identify substantial gaps in the primary literature and inform the scope of future pattern\u2010specific diagnostic test accuracy systematic reviews.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70389","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:09:32Z","timestamp":1785733772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evidence for Electrocardiographic Patterns Identifying Acute Coronary Occlusion in Non\u2010\n                    <scp>ST<\/scp>\n                    \u2010Elevation Acute Coronary Syndromes: A Scoping Review"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8463-6936","authenticated-orcid":false,"given":"Andrew P.","family":"Grimes","sequence":"first","affiliation":[{"name":"School of Nursing, Paramedicine and Healthcare Sciences Charles Sturt University  Bathurst New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2348-6977","authenticated-orcid":false,"given":"Sonja J.","family":"Maria","sequence":"additional","affiliation":[{"name":"School of Nursing, Paramedicine and Healthcare Sciences Charles Sturt University  Bathurst New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad191"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.07.053"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.11.009"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101314"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(96)00392-0"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.4081\/ecj.2025.14233"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2024.131889"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054\u2010018\u20101944\u2010x"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx418"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2023.08.022"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2023.09.020"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/clc.23781"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.25259\/IJMR_1781_2025"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2020.10.026"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2020.100603"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acepjo.2025.100240"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874\u2010018\u20100611\u2010x"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.11124\/JBIES\u201021\u201000242"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.7326\/M18\u20100850"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.20452\/pamw.4018"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcha.2021.100868"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.46658\/JBIMES-24-01"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119756194.ch6"},{"key":"e_1_2_13_25_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions. 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