October 8, 2020

Background: Prior to the discovery of thrombolytics, clinicians could only observe their patients completing their myocardial infarctions and then classify them according to whether their subsequent ECGs developed Q waves. When trials showed a clear survival benefit with thrombolytics (especially in STE) this shifted the paradigm from “Q-wave/ non Q-wave MI” to “STEMI / non-STEMI”. Eventually STEMI became synonymous with acute coronary occlusion (ACO) requiring reperfusion, except this connection was never studied in trials. Unfortunately, the STEMI criteria have limited diagnostic criteria for ACO, leading to false cath lab activation. And worse, missing ⅓ of ACO (NSTEMI), depriving them of emergent reperfusion therapy. This led many authors to shift from STEMI/ NSTEMI to ACO-MI/ non- ACO-MI.