emDocs.net, one of my favorite online resources, just published an article reviewing the ACC/AHA STEMI diagnostic criteria, and also the EKG findings that are considered STEMI equivalents. Also, since only 60% of patients with occlusive MIs found during catheterization actually met STEMI criteria, many are pushing to rename the classic ST Elevated Myocardial Infarction (STEMI) to Occlusion Myocardial Infarction (OMI) and NSTEMI to NOMI respectively.
It does seem quite silly to base the name of occlusion MIs off an EKG finding that is only present in 60% of those cases. This is where the STEMI equivalents come in, and hopefully a renaming down the road. I’ve included the Cliff Notes below for rapid access on shift, please though, review the linked article on emDocs.net for EKG examples and case reviews.
STEMI + STEMI Equivalents = OMI (likely)
STEMI Criteria
-Men < 40-years-old: ST elevation ≥5 mm in V2 or V3, or ≥1 mm in any other leads
-Men ≥ 40-years-old: ST elevation ≥2 mm in V2 or V3, or ≥1 mm in any other leads
-Women, regardless of age: ST elevation ≥5 mm in V2 or V3, or ≥1 mm in any other leads
STEMI Equivalents
-Posterior STEMI
-LBBB with Sgarbossa criteria or Smith-modified Sgarbossa criteria
-Ventricular-paced rhythm with Sgarbossa criteria or Smith-modified Sgarbossa criteria
-De Winter Sign
-Hyperacute T-waves
Posterior STEMI
-Horizontal ST-segment depression in V1-V3
-Dominant R-wave (i.e., R-to-S ratio > 1) in V2
-Upright T-waves in anterior leads
-Prominent and broad R-wave (>30 ms)
-Confirmed by ST-segment elevation of 0.5mm in at least 1 of leads V7-V9
Smith-modified Sgarbossa Criteria (LBBB or V-paced rhythm)
-Concordant ST-segment elevation of ≥ 1 mm in leads with a positive QRS complex
-Concordant ST-segment depression of ≥ 1 mm in V1-V3
-ST-segment elevation at the J-point, relative to the QRS onset, is at leads 1 mm and has an amplitude of at least 25% of the preceding S-wave
De Winter Sign
-Tall, prominent, symmetrical T-waves that arise from an upsloping ST-segment depression > 1 mm at the J-point in precordial leads
-0.5-1 mm ST-segment elevation in aVR
Hyperacute T-waves
-Morphology can be variable, but includes broad, asymmetric, peaked T-waves. This may indicate evidence of early coronary artery occlusion
-More consistently you will see T-waves that are large relative the QRS and often the R wave amplitude is reduced
-Serial ECGs over very short intervals should be used to judge progression to STEMI
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