From the Guidelines
A STEMI (ST-Elevation Myocardial Infarction) is defined as a clinical syndrome characterized by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis, with diagnostic ST elevation defined by new ST elevation at the J point in at least 2 contiguous leads of ≥2 mm (0.2 mV) in men or ≥1.5 mm (0.15 mV) in women in leads V2–V3 and/or of ≥1 mm (0.1 mV) in other contiguous chest leads or the limb leads 1.
Key Characteristics of STEMI
- Characteristic symptoms of myocardial ischemia
- Persistent electrocardiographic (ECG) ST elevation
- Subsequent release of biomarkers of myocardial necrosis
- Diagnostic ST elevation defined by specific criteria in contiguous leads
Diagnostic Criteria
- New ST elevation at the J point in at least 2 contiguous leads of ≥2 mm (0.2 mV) in men or ≥1.5 mm (0.15 mV) in women in leads V2–V3
- New ST elevation at the J point of ≥1 mm (0.1 mV) in other contiguous chest leads or the limb leads
Importance of Prompt Diagnosis and Treatment
- STEMI is a medical emergency requiring immediate treatment to restore blood flow and minimize heart muscle damage
- Prompt diagnosis and treatment are critical to improve outcomes and reduce morbidity and mortality 1
From the Research
Definition of STEMI
- ST-segment elevation myocardial infarction (STEMI) is defined as a complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel, causing great morbidity and mortality 2.
- It is the most acute manifestation of coronary artery disease, requiring early diagnosis and immediate reperfusion to limit myocardial ischemia and infarct size 2.
- STEMI is characterized by pathologic ST-segment elevation occurring in at least 2 anatomically contiguous leads in a patient with a clinical presentation consistent with acute myocardial infarction (AMI) 3.
Key Characteristics
- STEMI is caused by a complete blockage of a coronary artery, resulting in damage to the heart muscle 4.
- It is a major cause of morbidity, mortality, and disability, requiring rapid transport to a percutaneous coronary intervention (PCI) center for treatment 4.
- STEMI can be associated with other sinister electrocardiogram (EKG) patterns, such as right bundle branch block (RBBB), which can indicate more extensive myocardial involvement and a worse prognosis 5.
Diagnosis and Treatment
- Early diagnosis and treatment of STEMI are crucial to reduce the risk of post-STEMI complications and heart failure 2.
- Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with STEMI, with fibrinolysis therapy as an alternative if PCI cannot be performed within 120 minutes of STEMI diagnosis 2.
- Coronary angiography is recommended for all patients with STEMI, and advances in adjunctive pharmacological and device therapy have improved primary PCI results 4.