Coronary disease & ACSSecondary analysis
Impact of guidelines-directed very-high-risk criteria in the identification and management of occlusion myocardial infarction in patients with NSTE-ACS
- post-hoc analysis
Authors' conclusion
Guideline-directed VHR criteria had limited sensitivity for OMI and rarely translated into guideline-recommended immediate PCI. Current NSTE-ACS classification and triage strategies require reconsideration to improve recognition and timely reperfusion of acute coronary occlusion.
Study context
- Population
- NSTE-ACS patients undergoing percutaneous coronary intervention (PCI) in the MATRIX programme with available culprit-lesion flowNSTE-ACS patients undergoing PCI with available culprit-lesion flow
- Participants
- 2,979 patients
- Comparison
- European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) very high-risk (VHR) criteria for occlusion myocardial infarction (OMI) detection and time from first medical contact (FMC) to PCI
Primary result
As reported in the abstract
OMI (culprit-vessel TIMI flow 0-1)
OMI occurred
592 patients (19.9%)
Further findings
At least one VHR criterion present
VHR criteria fulfilled among patients with OMI · among patients with OMI
PCI within 2 h
| Outcome | median FMC-to-PCI time (h) | P value |
|---|---|---|
| Median FMC-to-PCI time — fulfilling ESC criteria vs not fulfilling ESC criteria · shorter in patients fulfilling ESC criteria | 27.0 vs. 40.5 h | P < 0.001 |
| Median FMC-to-PCI time — fulfilling ACC/AHA VHR criteria vs not fulfilling ACC/AHA VHR criteria · shorter in patients fulfilling ACC/AHA VHR criteria | 12.2 vs. 69.9 h | P < 0.001 |
- PCI within 2 h — patients with OMI
- 3.6%
Timely reperfusion within 2 h among OMI patients fulfilling VHR criteria
- OMI patients fulfilling VHR criteria (first)
- 4.7%
- OMI patients fulfilling VHR criteria (second)
- 9.9%
- among OMI patients fulfilling VHR criteria
Original publication
Impact of guidelines-directed very-high-risk criteria in the identification and management of occlusion myocardial infarction in patients with NSTE-ACS. Eur Heart J Acute Cardiovasc Care. Published 17 August 2026. doi:10.1093/ehjacc/zuag096
Summarised from the published abstract; every number is checked against it