What are the criteria for ST-Elevation Myocardial Infarction (STEMI)?

From the Guidelines

STEMI is diagnosed based on specific ECG criteria, including ST-segment elevation of ≥2 mm in men ≥40 years old and ≥2.5 mm in men <40 years old in leads V2-V3, and ≥1 mm in all other leads, as well as equivalent changes such as new LBBB or posterior MI, as outlined in the 2017 ESC guidelines 1. The diagnosis of STEMI is primarily based on ECG findings, which are critical for initiating timely reperfusion therapy. The ECG criteria for STEMI, as recommended by the 2017 ESC guidelines 1, include:

• ST-segment elevation of ≥2 mm in men ≥40 years old and ≥2.5 mm in men <40 years old in leads V2-V3
• ST-segment elevation of ≥1 mm in all other leads
• ST-segment elevation of ≥1.5 mm in women in leads V2-V3
• New left bundle branch block (LBBB) with appropriate clinical context
• Posterior MI suggested by ST depression of ≥0.5 mm in leads V1-V3 with tall R waves and upright T waves These ECG findings, combined with symptoms like chest pain, shortness of breath, or diaphoresis, warrant immediate reperfusion therapy. The 2010 American Heart Association guidelines 1 also provide similar criteria, but the 2017 ESC guidelines 1 are more recent and provide a more comprehensive approach to STEMI diagnosis and management. The importance of timely reperfusion therapy cannot be overstated, as it significantly impacts morbidity, mortality, and quality of life outcomes in STEMI patients. Therefore, it is crucial to adhere to the ECG criteria outlined in the 2017 ESC guidelines 1 to ensure prompt and accurate diagnosis of STEMI. Key points to consider in the diagnosis and management of STEMI include:
• Initiating ECG monitoring as soon as possible to detect life-threatening arrhythmias
• Acquiring and interpreting a 12-lead ECG as soon as possible at the time of first medical contact
• Repeating ECGs if the initial ECG is equivocal or does not show evidence to support the clinical suspicion of MI
• Considering field transmission of the ECG if interpretation is not possible on-site
• Initiating reperfusion therapy as soon as possible in patients with a clinical suspicion of myocardial ischemia and ST-segment elevation.

From the FDA Drug Label

Patients with ST-elevation myocardial infarction (STEMI) when managed with either primary or delayed PCI (1. 1). The FDA drug label does not answer the question.

From the Research

Criteria for ST-Elevation Myocardial Infarction (STEMI)

The criteria for STEMI are not explicitly stated in the provided studies, but the following information can be gathered:

• STEMI is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality 2
• A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases 2
• STEMI is characterized by ST-segment elevation on the electrocardiogram, which indicates complete obstruction to coronary artery blood flow 3
• The diagnosis of STEMI can be challenging, especially in patients with right bundle branch block (RBBB), as the current voltage criteria for identification of anterior STEMI may not be sufficient 4

Key Characteristics of STEMI

Some key characteristics of STEMI include:

• Complete thrombotic occlusion of an epicardial coronary vessel 2
• ST-segment elevation on the electrocardiogram 3
• Acute manifestation of coronary artery disease 2
• High morbidity and mortality 2

Reperfusion Strategies for STEMI

Reperfusion strategies for STEMI include:

• Primary percutaneous coronary intervention (PCI) 2, 5
• Fibrinolysis therapy 2, 6
• Dual antiplatelet therapy (DAPT) with combination of a P2Y12 inhibitor and acetylsalicylic acid (ASA) 5