From the Guidelines
Non-ST-Elevation Myocardial Infarction (NSTEMI) is defined as a type of acute coronary syndrome (ACS) characterized by the absence of persistent ST-segment elevation on the electrocardiogram (ECG) and the presence of elevated cardiac biomarkers, such as troponin, indicating myocardial necrosis.
Key Characteristics of NSTEMI
- The diagnosis of NSTEMI is based on the presence of elevated cardiac biomarkers, such as troponin, and clinical evidence of myocardial ischemia 1
- NSTEMI is distinguished from unstable angina (UA) by the presence of elevated cardiac biomarkers, which indicate myocardial damage 1
- The absence of persistent ST-segment elevation on the ECG is a key characteristic of NSTEMI, which differentiates it from ST-elevation myocardial infarction (STEMI) 1
- NSTEMI can present with ST depression, transient ST-elevation, and/or prominent T-wave inversions on the ECG, but these findings are not required for diagnosis 1
Clinical Context
- The diagnosis of NSTEMI requires interpretation of the ECG and cardiac biomarkers in the context of the patient's clinical presentation 1
- The clinical presentation of NSTEMI can vary, but it is often characterized by ischemic chest pain and evidence of myocardial ischemia on the ECG or cardiac biomarkers 1
- NSTEMI is a type of acute coronary syndrome, which also includes UA and STEMI, and is characterized by a spectrum of clinical presentations 1
From the Research
Definition of Non-ST-Elevation Myocardial Infarction (NSTEMI)
- Non-ST-segment elevation myocardial infarction (NSTEMI) is defined as elevated cardiac biomarkers of necrosis in the absence of persistent ST-segment elevation in the setting of anginal symptoms or other acute event 2.
- NSTEMI may result from an acute atherothrombotic event ('Type 1') or as the result of other causes of mismatch of myocardial oxygen supply and demand ('Type 2') 2.
- It is characterized by an acute, critical increase in the already existing high microvascular resistance in addition to the subtotal coronary artery occlusion 3.
Key Characteristics of NSTEMI
- NSTEMI represents the highest risk category of non-ST-segment elevation acute coronary syndromes (NSTEACS) 4.
- It is a major cause of cardiovascular morbidity and mortality in the United States 4.
- NSTEMI patients often have a higher comorbidity burden and diverse etiologies, which add complexity to therapeutic decision-making 2.
Diagnosis and Management of NSTEMI
- Timely diagnosis and appropriate therapy are paramount to improve outcomes in NSTEMI patients 4.
- Evidence-based treatment, with combination of antiplatelet and anticoagulant therapy, and with serious consideration of early coronary angiography and revascularization along with anti-ischemic medical therapy, is the mainstay of management for NSTEMI 4.
- Applying in practice the American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations results in improved outcomes 4.