{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T17:10:14Z","timestamp":1793898614484,"version":"4.8.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T00:00:00Z","timestamp":1759190400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Egypt Heart J"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The current STEMI criteria fail to detect roughly one\u2010third of occlusive MI (OMI). STEMI criteria demonstrated only a sensitivity of around 21% for OMI. Compared to STEMI, patients with NSTEMI-OMI have higher short-term and long-term all-cause mortality and longer reperfusion delays. This case series presents three NSTEMI patients with OMI and a delayed reperfusion strategy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Case presentation<\/jats:title>\n            <jats:p>We present three cases of patients initially diagnosed with NSTEMI who were later found to have occlusive myocardial infarction (OMI) based on angiographic findings, all of whom underwent delayed reperfusion strategies. The first two cases shared similar clinical profiles, presenting with typical infarct angina, elevated cardiac enzymes, and regional wall motion abnormalities on echocardiography. Their electrocardiograms showed bifascicular blocks, right bundle branch block (RBBB) with left posterior fascicular block (LPFB) in the first case, and RBBB with left anterior fascicular block (LAFB) in the second. Both were classified as high-risk NSTEMI and scheduled for an early invasive approach. Angiography revealed total occlusions in the OM1 and left main arteries, respectively. In the third case, the patient presented with new-onset angina and elevated cardiac biomarkers, but without ECG features fulfilling STEMI or high-risk OMI criteria. However, due to persistent chest pain despite initial treatment in the emergency department, an immediate invasive strategy was pursued. Coronary angiography revealed a total occlusion in the proximal left anterior descending (LAD) artery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>These three cases underscore the diagnostic challenge of identifying occlusive myocardial infarction (OMI) in patients presenting with acute coronary syndrome (ACS) when relying exclusively on traditional STEMI criteria. They emphasize the need to recognize alternative ECG markers indicative of acute coronary occlusion, as failure to do so may result in delayed reperfusion and subsequently worse clinical outcomes compared to patients who receive timely intervention based on prompt STEMI recognition.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s43044-025-00688-2","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T07:45:57Z","timestamp":1759218357000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A case series of OMI: time for revisiting STEMI\/NSTEMI ECG criteria"],"prefix":"10.1186","volume":"77","author":[{"given":"Edwin Adhi Darmawan","family":"Batubara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bambang","family":"Widyantoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siska Suridanda","family":"Danny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dafsah Arifa","family":"Juzar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,30]]},"reference":[{"issue":"11","key":"688_CR1","doi-asserted-by":"crossref","first-page":"101314","DOI":"10.1016\/j.jacadv.2024.101314","volume":"3","author":"J McLaren","year":"2024","unstructured":"McLaren J, de Alencar JN, Aslanger EK, Meyers HP, Smith SW (2024) From ST-segment elevation MI to occlusion MI. JACC Adv 3(11):101314","journal-title":"JACC Adv"},{"key":"688_CR2","doi-asserted-by":"crossref","unstructured":"Kola M, Shuka N, Meyers HP, Zaimi (Petrela) E, Smith SW (2024) OMI\/Nomi: time for a new classification of acute myocardial infarction. J Clin Med","DOI":"10.20944\/preprints202407.1220.v1"},{"key":"688_CR3","doi-asserted-by":"crossref","first-page":"100767","DOI":"10.1016\/j.ijcha.2021.100767","volume":"33","author":"H Pendell Meyers","year":"2021","unstructured":"Pendell Meyers H, Bracey A, Lee D, Lichtenheld A, Li WJ, Singer DD et al (2021) Accuracy of OMI ECG findings versus Stemi criteria for acute coronary occlusion myocardial infarction diagnosis. IJC Heart Vasculat 33:100767","journal-title":"IJC Heart Vasculat"},{"issue":"1","key":"688_CR4","first-page":"e78","volume":"10","author":"G Avdikos","year":"2022","unstructured":"Avdikos G, Michas G, Smith SW (2022) From Q\/Non-Q myocardial infarction to STEMI\/NSTEMI: why it\u2019s time to consider another simplified dichotomy; a narrative literature review. Arch Acad Emerg Med 10(1):e78","journal-title":"Arch Acad Emerg Med"},{"key":"688_CR5","doi-asserted-by":"crossref","first-page":"131889","DOI":"10.1016\/j.ijcard.2024.131889","volume":"402","author":"J Nunes","year":"2024","unstructured":"Nunes J, Scheffer MK, Correia BP, Franchini KG, Felicioni SP, Fuziy M (2024) Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion. Int J Cardiol 402:131889\u2013131899","journal-title":"Int J Cardiol"},{"key":"688_CR6","volume":"33","author":"H Pendell Meyers","year":"2021","unstructured":"Pendell Meyers H et al (2021) Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. IJC Heart Vasc 33:100767","journal-title":"IJC Heart Vasc"},{"issue":"4","key":"688_CR7","first-page":"e362","volume":"127","author":"PT O'Gara","year":"2013","unstructured":"O\u2019Gara PT et al (2013) 2013 ACCF\/AHA Guideline for the Management of ST-elevation Myocardial infarction: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. Circulation 127(4):e362-425","journal-title":"Circulation"},{"issue":"2","key":"688_CR8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","volume":"39","author":"B Ibanez","year":"2017","unstructured":"Ibanez B, James S, Agewall S (2017) ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 39(2):119\u2013177","journal-title":"Eur Heart J"},{"key":"688_CR9","first-page":"100603","volume":"30","author":"EK Aslanger","year":"2020","unstructured":"Aslanger EK, Y\u0131ld\u0131r\u0131mt\u00fcrk \u00d6, \u015eim\u015fek B et al (2020) Diagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resulting in myocardial infarction (DIFOCCULT Study). Int J Cardiol Heart Vasc 30:100603","journal-title":"Int J Cardiol Heart Vasc"},{"issue":"1","key":"688_CR10","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/eurheartj\/ehr291","volume":"33","author":"P Widimsky","year":"2012","unstructured":"Widimsky P, Roh\u00e1c F, St\u00e1sek J, Kala P, Rokyta R, Kuzmanov B et al (2012) Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy? 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Eur Heart J 5(2):123\u2013133","journal-title":"Eur Heart J"},{"issue":"Supplement_2","key":"688_CR17","doi-asserted-by":"crossref","first-page":"ehad655.1536","DOI":"10.1093\/eurheartj\/ehad655.1536","volume":"44","author":"R Herman","year":"2023","unstructured":"Herman R, Smith SW, Meyers HP, Bertolone DT, Leone A, Bermpeis K et al (2023) Poor prognosis of total culprit artery occlusion in patients presenting with NSTEMI. Eur Heart J 44(Supplement_2):ehad655.1536","journal-title":"Eur Heart J"},{"issue":"7","key":"688_CR18","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1038\/s41591-023-02396-3","volume":"29","author":"SS Al-Zaiti","year":"2023","unstructured":"Al-Zaiti SS, Martin-Gill C, Z\u00e8gre-Hemsey JK, Bouzid Z, Faramand Z, Alrawashdeh MO et al (2023) Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction. Nat Med 29(7):1804\u20131813","journal-title":"Nat Med"}],"container-title":["The Egyptian Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43044-025-00688-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43044-025-00688-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43044-025-00688-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T20:03:03Z","timestamp":1759262583000},"score":1,"resource":{"primary":{"URL":"https:\/\/tehj.springeropen.com\/articles\/10.1186\/s43044-025-00688-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,30]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["688"],"URL":"https:\/\/doi.org\/10.1186\/s43044-025-00688-2","relation":{},"ISSN":["2090-911X"],"issn-type":[{"value":"2090-911X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,30]]},"assertion":[{"value":"19 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures followed in this report were by the ethical standard of the Declaration of Helsinki 2013. The subjects of the patient for this case report is under the ethical clearance registry. The Name of the ethics committee is the Research Ethics Committee of the National Cardiovascular Center Harapan Kita, The reference number: DP.04.03\/KEP056\/EC023\/2024.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for inclusion in this case report, ensuring that no identifying information has been disclosed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"90"}}