{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:54:11Z","timestamp":1791176051416,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>An estimated 25%\u201334% of patients with non\u2013ST-segment elevation acute coronary syndrome (NSTE-ACS) are diagnosed with an occluded culprit artery during catheterization. Whether early serial troponin kinetics discriminate angiographically defined occlusion myocardial infarction (OMI) in catheterized patients with NSTE-ACS remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective cohort study of 481 patients with NSTE-ACS who underwent coronary catheterization between 2017 and 2023. OMI was defined by a purely angiographic criterion: &amp;gt;90% culprit-vessel stenosis with Thrombolysis in Myocardial Infarction flow grade 0, 1, or 2. Seven contemporary sensitivity troponin I metrics (absolute values at 0, 3, and 6\u2005h; deltas; and ratios) were evaluated by receiver operating characteristic analysis. Operating characteristics are reported with 95% confidence intervals (CIs) and likelihood ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ninety-eight patients (20.4%) met the angiographic definition of OMI. These patients were younger (median, 65.5 vs. 70.0 years;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025), had fewer comorbidities, and more often presented with chest pain (92.9% vs. 82.8%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). The left circumflex artery was the most common culprit in OMI (36.7%). Twenty-nine patients with OMI (29.6%) had a presentation ECG classified as normal (no ST\u2013T change or bundle branch block. No troponin metric reliably discriminated OMI from non-occlusion MI. The prespecified primary predictor, the 0\u20136-h change in troponin concentration, had an area under the curve (AUC) of 0.623 (95% CI, 0.544\u20130.703) and the best single metric, the 6-h value, of 0.654 (0.580\u20130.727); all seven unadjusted troponin-metric AUCs were under 0.66. At its Youden cutoff (\u22650.379\u2005ng\/mL), the 6-h troponin had a sensitivity of 69.4%, a specificity of 57.7%, a positive predictive value of 27.2%, and a negative predictive value of 89.3%. The highest positive predictive value of any metric was 41.3%, the first troponin (at 0\u2005h) identified fewer than 40% of patients with OMI at its optimal threshold, and likelihood ratios produced only limited shifts in post-test probability.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among analyzable patients with NSTE-ACS undergoing catheterization, approximately one in five met the study-defined angiographic criteria for OMI. Early serial troponin kinetics showed only modest discrimination, and upper confidence bounds fell below levels expected of a standalone triage biomarker. Complementary strategies for identifying these patients, including expert ECG interpretation, warrant further study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1903711","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:37:25Z","timestamp":1791175045000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Angiographic prevalence of occlusion myocardial infarction and the limited value of serial troponin in patients with non\u2013ST-segment elevation acute coronary syndrome"],"prefix":"10.3389","volume":"13","author":[{"given":"Sajid","family":"Kadir","sequence":"first","affiliation":[{"name":"Pepin Heart Institute, AdventHealth Tampa","place":["Tampa, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Sasidharan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University 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