Failure of standard contemporary ST-elevation myocardial infarction electrocardiogram criteria to reliably identify acute occlusion of the left anterior descending coronary artery
Authors' conclusion
The STEMI criteria missed 38% of acute total LAD occlusions on all serial ECGs. Both expert interpretation and the AI model demonstrated 100% sensitivity on the first ECG for all cases. Despite the lack of STEMI criteria, these cases had similar infarct sizes but were associated with longer DBTs.
Study context
- Population
- Cases of acute total (TIMI-0 flow) left anterior descending (LAD) coronary artery occlusion myocardial infarctioncases of acute LAD OMI with TIMI-0 flow, parent study 808 patients, 265 with OMI
- Participants
- 53 cases
- Comparison
- We compared ST-elevation (STE) criteria with expert interpretation and a validated artificial intelligence (AI) electrocardiogram (ECG) model for diagnosing LAD OMI.
Primary result
As reported in the abstract
Not meeting STEMI criteria on any pre-angiography ECG
STE criteria
38%
20 events
- Of these 20, had at least two ECGs before angiography
- 16/20
Further findings
Sensitivity
| Outcome | STE criteria | Expert interpretation | AI model | |
|---|---|---|---|---|
| Sensitivity for diagnosing LAD OMI on the first ECG in the 20 cases without STEMI criteria | Not reported in the abstract | 100% | 100% | STE criteria: not reported in the abstract |
Door-to-balloon time (DBT)
- Significantly shorter for those meeting STE myocardial infarction (STEMI) criteria
Infarct size (ejection fraction and peak troponin)
- Did not differ between cases with and without STEMI criteria
Original publication
Failure of standard contemporary ST-elevation myocardial infarction electrocardiogram criteria to reliably identify acute occlusion of the left anterior descending coronary artery. Eur Heart J Acute Cardiovasc Care. Published 28 July 2025. doi:10.
Summarised from the published abstract; every number is checked against it