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Culprit Vessel Distribution Does Not Predict OMI Reclassification in Acute Coronary Syndromes
Session:
Sessão de Posters 34 - INOCA, MINOCA e a zona cinzenta da doença coronária
Speaker:
André Filipe Silva Pereira Martins Lobo
Congress:
CPC 2026
Topic:
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Session Type:
Posters Eletrónicos
FP Number:
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Authors:
Marta Leite; André Lobo; Francisca Nunes; Francisco Sousa; Leonor Moura; Marta Almeida; Fabio Nunes; Gualter Santos Silva; Claúdio Espada Guerreiro; Francisco Sampaio; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p><strong>Introduction:</strong><br /> The Occlusion Myocardial Infarction (OMI) framework challenges the traditional STEMI-based approach by emphasizing direct identification of coronary occlusion rather than relying solely on ECG criteria. This study examined whether the culprit vessel influences reclassification patterns when applying the OMI paradigm.</p> <p><strong>Methods:</strong><br /> We retrospectively analyzed 330 ACS patients initially classified as STEMI or NSTEMI. OMI was defined by angiographic occlusion (TIMI flow ≤2) and/or markedly elevated troponin levels (Troponin T >1000 ng/L or Troponin I >5000 ng/L) in the presence of regional wall motion abnormalities. Patients were then stratified into STEMI, NSTEMI-OMI, or NSTEMI-non-OMI. Culprit vessels were categorized as left main (LM), left anterior descending (LAD), left circumflex (LCx), or right coronary artery (RCA).</p> <p><strong>Results:</strong><br /> Of 327 patients with complete data, 193 (59.0%) were STEMI. Their culprit vessels were LAD in 91 cases (47.2%), RCA in 60 (31.1%), LCx in 39 (20.2%), and LM in 3 (1.6%). Among 134 NSTEMI patients, OMI reclassification identified 52 NSTEMI-OMI and 82 NSTEMI-non-OMI. In NSTEMI-OMI, culprit vessels were RCA in 23 cases (44.2%), LAD in 18 (34.6%), and LCx in 9 (17.3%). In NSTEMI-non-OMI, the LAD accounted for 38 cases (46.3%), the RCA for 27 (32.9%), and the LCx for 16 (19.5%).<br /> When examined by vessel territory, LAD lesions (n=147) were classified as STEMI in 61.9%, NSTEMI-OMI in 12.2%, and NSTEMI-non-OMI in 25.9%. For RCA lesions (n=110), these proportions were 54.5%, 20.9%, and 24.5%, respectively. LCx lesions (n=64) showed a similar distribution. Although RCA lesions showed a numerical trend toward higher misclassification, differences across territories were not statistically significant (p=0.522).</p> <p><strong>Discussion:</strong><br /> OMI misclassification occurred across all coronary territories, indicating that diagnostic under-recognition is not driven by anatomical distribution alone.</p> <p><strong>Conclusion:</strong><br /> Coronary occlusion consistent with the OMI framework may arise in any vascular territory, independent of culprit vessel location, underscoring the need for diagnostic strategies beyond traditional ECG-based STEMI criteria.</p>
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