OMI GOD, IT’S MYOCARDIAL INFARCTION!

Abstract

TYPE: Case Report TOPIC: Critical Care INTRODUCTION: Acute Coronary Syndromes (ACS) caused by Occlusion Myocardial Infarctions (OMI) are potentially treatable events with percutaneous coronary interventions (PCI). A ST-elevation myocardial infarction (STEMI) is classically used to diagnose OMI, besides being an imperfect surrogate. CASE PRESENTATION: An 89-year-old man with a history of a valvular and ischemic cardiopathy [synchronous aortic biologic prosthesis insertion and coronary arterial bypass graft due to left anterior descendant artery (LAD) occlusion nine years ago] was admitted for a 3-weeks exertional dyspnea. He had already consulted health care services thrice for the same reason, always directly discharged. At presentation, he had no remarkable findings. An electrocardiogram revealed a normal sinus rhythm, a previous known complete right bundle branch block, new-onset ST-elevation in aVR, ST-depression in V4-V6 and hyperacute T waves in V1-V3. Laboratory values revealed Troponin I (0.86 ug/L) and NTproBNP (4896 pg/ml) elevation. A transthoracic echocardiogram revealed mild systolic left ventricular function. An ACS with NSTEMI was admitted, besides suggestion of OMI. A late catheterization was performed, revealing a >90% right coronary artery stenosis, and a PCI was finally performed with success. DISCUSSION: Under the STEMI/NSTEMI dichotomic paradigm, up to 30% ACS classified as NSTEMI are missed OMI, as well as up to 30% ACS classified as STEMI lead to unnecessary urgent catheterization. The OMI/nonOMI classification encompasses both STEMI and STEMI-equivalents, being a more accurate way of stratifying ACS that require PCI. CONCLUSIONS: ACS due to OMI was repeatedly misdiagnosed and classified as NSTEMI along the 3-weeks course. Therefore, is mandatory not to overlook STEMI equivalents and OMI in order to better rationalize urgent treatment DISCLOSURE: Nothing to declare. KEYWORD: OMI