STEMI and NSTEMI may be giving way to occlusion MI (OMI) in clinical literature

By Brian Murphy

 

Could STEMI change to OMI?

 

A recent study published in the journal JACC: Advances of ST elevation MI (STEMI) and non-STEMI (NSTEMI) concludes the time has come.

 

STEMI and NSTEMI are familiar terms for coding and CDI professionals. But the study says they are often inadequate for accurate diagnosis, resulting in false negatives and delays in intervention. And instead recommends occlusion MI (OMI).

 

As always, I caveat these types of articles by stating that I’m neither a coder nor a clinician, just an interested observer offering this up in case you missed it.

 

I recommend reading the study but also the Medscape article below, which offers a nice summary by a cardiologist offering his opinion of the paper (spoiler alert—he agrees with it). He summarizes the current STEMI problem as follows:

 

“ST elevation on the ECG of a patient with chest pain equals a coronary occlusion. That puts this person on the emergent percutaneous coronary intervention (PCI) train. And with this come the quality metrics of door-to-balloon time.

 

But a patient with similarly classic chest pain, whose human reader of the ECG does not declare ST elevation is diagnosed with NSTEMI and is not placed on the emergent PCI train. The problem with this paradigm is that many patients with NSTEMI actually have an occluded coronary. And thus, would benefit from emergent PCI. This is the false negative problem.

 

In addition, some patients with ST elevation do not have an occluded vessel. The false positive problem is not as big a problem as delayed opening of an occluded artery.”

 

The paper states that rather than triaging patients with chest pain into STEMI or NSTEMI, they propose the language of OMI vs. non-OMI. Why? Per statistics cited in the article:

 

• Half of patients with acutely occluded coronary arteries do NOT exhibit obvious ST elevation.
• Nearly one in three patients diagnosed with NSTEMI have acutely occluded coronary arteries.
• Less than 10% of patients having a “very high-risk” NSTEMI have PCI in under 2 hours

 

The article concludes with four suggestions to change the STEMI/NSTEMI paradigm:

 

1. Shift provider language and thought from STEMI/NSTEMI to OMI or non-OMI
2. Document accordingly. “With this distinction, quality initiatives and education can advance. False negatives can now be recognized,” the article states.
3. Change “code STEMI” language to “code OMI” or “acute coronary occlusion (ACO)” call teams.
4. Improve diagnosis in the ambulance or the ED (which the study admits is by far the hardest change).

 

Please note this is merely a study, and it remains to be seen if it will be adopted into clinical practice.

 

Correct me if I’m wrong coders, but if a provider documents “OMI,” the coder must confirm if it qualifies as an AMI. If unclear the CDI or coder should query the provider for clarification.

 

What do your physicians think of STEMI/NSTEMI classifications, and have they shown any dissatisfaction with it? Has OMI appeared in the medical record during your chart reviews?

 

References

• JACC: Advances, From ST-Segment Elevation MI to Occlusion MI: The New Paradigm Shift in Acute Myocardial Infarction: https://www.sciencedirect.com/science/article/pii/S2772963X24005933?via%3Dihub
• Medscape, the Week in Cardiology Podcast (article starts near the bottom of the page): https://www.medscape.com/viewarticle/1001735#vp_2