Thread by @PulmCrit

OMI vs. NOMI: The STEMI/NSTEMI is a failed pardigm!
- many NSTEMI have occlusion
- many STEMI don't have occlusion
- @PendellM at #HRreloaded

- we've tried putting band-aids on STEMI.
- the list of STEMI-equivalents keeps growing!
- unfortunately there's no consistent approach to these (cath lab may refuse to activate)
- @PendellM at #HRreloaded

- STEMI algorithm evolved from prior QWMI/NQWMI pardigm, based on RCTs involving thrombolysis
- STEMI is an improvement on ignoring EKG entirely, but it's deeply flawed
- OMI is the next pardigm
- @PendellM at #HRreloaded

NSTEMI RCTs show that 25% of patients with NSTEMI have complete occlusion! such patients are treated sub-optimally and often do poorly
- @PendellM at #HRreloaded

the STEMI paradigm perpetuates itself due to circular logic. it's difficult to have a "false-negative" STEMI based on the way it is defined.
- @PendellM at #HRreloaded

hyperacute T-waves occur earlier than STE. why can't we identify hyperacute T-waves to use them as a tool to guide early reperfusion? cardiology literature largely ignores hyperacute T-waves, favoring delay until STE occurs 😬
- @PendellM at #HRreloaded

focus on absolute STE and ST segment places blinders on us preventing global understanding of EKGs and patients
- @PendellM at #HRreloaded

woah. OMI pardigm may move away purely focusing on EKG, to integrate with *POCUS* and H&P. 🤯
#ThisIsTheWay
- @PendellM at #HRreloaded