Diagnostic Criteria and Management for Occlusion Myocardial Infarction (OMI)

Diagnostic Criteria for OMI

The European Society of Cardiology recommends traditional STEMI criteria, including ≥2.5 mm ST-elevation in men <40 years in leads V2-V3, ≥2 mm ST-elevation in men ≥40 years in leads V2-V3, ≥1.5 mm ST-elevation in women in leads V2-V3, and ≥1 mm ST-elevation in other leads (in absence of LV hypertrophy or LBBB) 1
The European Society of Cardiology also recommends considering OMI-specific ECG patterns, including hyperacute T-waves preceding ST-elevation and ST-depression in multiple leads with ST-elevation in aVR (left main or multivessel disease) 2
The American College of Cardiology recommends symptoms of myocardial ischemia (chest pain, dyspnea, etc.) and cardiac biomarker elevation (preferably cardiac troponin) with at least one value above the 99th percentile upper reference limit 3

The American College of Cardiology recommends immediate ECG within 10 minutes of arrival for all patients with suspected ACS, and continuous cardiac monitoring with emergency resuscitation equipment available 4
The European Society of Cardiology recommends oxygen therapy only if SaO₂ <90% or PaO₂ <60 mmHg, and pain relief with titrated IV opioids 5, 1
The European Society of Cardiology recommends primary PCI as the preferred reperfusion strategy for all OMI patients, which should be performed as soon as possible, ideally within 90-120 minutes of first medical contact 1, 6
The European Society of Cardiology recommends fibrinolytic therapy if PCI cannot be performed in a timely manner, using fibrin-specific agents (tenecteplase, alteplase, or reteplase) 6
The American Heart Association recommends aspirin (loading dose 162-325 mg, then 75-100 mg daily) as soon as possible, and a P2Y₁₂ inhibitor in addition to aspirin 7, 8, 6
The European Society of Cardiology recommends anticoagulation until revascularization or for duration of hospital stay, and high-intensity statin therapy started as early as possible 6
The European Society of Cardiology recommends beta-blockers for patients with heart failure and/or LVEF <40%, and ACE inhibitors within 24 hours for patients with heart failure, LV dysfunction, diabetes, or anterior infarct 6