Thursday 2 September 2021

Accuracy of OMI ECG findings vs traditional STEMI criteria for diagnosis of acute coronary occlusion MI... the OMI manifesto?

I’ve heard of many manifestos.

There’s the Communist Manifesto, the US Declaration of Independence, the Unabomber Manifesto and now we’ve got the OMI Manifesto.

(Ok… it’s not a freakin manifesto. But good to know about anyway.)

The charge is being led by the master sensei Dr Stephen Smith (of ECG blog fame) and his student Dr Pendell Meyers. They’ve published quite a few articles looking at additional ECG criteria to identify patients that may benefit from emergent reperfusion of an acute coronary occlusion.

They hypothesized that blinded interpretation of their new OMI criteria would be more accurate than the traditional STEMI criteria.

OMI criteria?

OMI (occlusion MI) is basically STEMI criteria plus some STEMI equivalents including:

Subtle STE not meeting criteria, hyperacute T waves, reciprocal ST depression and/or negative hyperacute T waves, STD worrisome for posterior MI, suspected new Q waves, terminal QRS distortion, positive Sgarbossa criteria, any inferior STE with SZTD or T wave inversion in aVL

Without going into any details of the study, they thought the OMI criteria were great. Sensitivity went up from about 40% to 85%. Specificity remained around 90%.

Unfortunately, the manuscript as published in the open access journal IJC Heart & Vasculature is quite difficult to follow. It is poorly presented and would have benefited from substantial revision. Either way, you don’t need to read it… the message is rather simple and has a degree of face validity (albeit with many limitations).

What are we to conclude?

If you are an expert at ECG interpretation, you can probably identify more patients with acute coronary occlusion MI by using OMI criteria (which most of us are already doing to some extent). Whether additional patients genuinely benefit from an aggressive intervention is officially not known.



Meyers P, Bracey A, Lee D, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. IJC Heart & Vasc. 2021:33; 100767 [link to full text article]

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