Brian Doyle, Viet Tran
I’ve heard of many manifestos.
There’s the Communist Manifesto, the US Declaration of Independence, the Unabomber Manifesto and now we’ve got the OMI Manifesto.
(Ok… it’s not a freakin manifesto. But good to know about anyway.
They hypothesized that blinded interpretation of their new OMI criteria would be more accurate than the traditional STEMI criteria.
OMI (occlusion MI) is basically STEMI criteria plus some STEMI equivalents including:
Subtle STE not meeting criteria, hyperacute T waves, reciprocal ST depression and/or negative hyperacute T waves, STD worrisome for posterior MI, suspected new Q waves, terminal QRS distortion, positive Sgarbossa criteria, any inferior STE with SZTD or T wave inversion in aVL
Without going into any details of the study, they thought the OMI criteria were great. Sensitivity went up from about 40% to 85%. Specificity remained around 90%.
Unfortunately, the manuscript as published in the open access journal IJC Heart & Vasculature is quite difficult to follow. It is poorly presented and would have benefited from substantial revision. Either way, you don’t need to read it… the message is rather simple and has a degree of face validity (albeit with many limitations).
What are we to conclude?
If you are an expert at ECG interpretation, you can probably identify more patients with acute coronary occlusion MI by using OMI criteria (which most of us are already doing to some extent). Whether additional patients genuinely benefit from an aggressive intervention is officially not known.
Meyers P, Bracey A, Lee D, et al. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. IJC Heart & Vasc. 2021:33; 100767 [link to full text article
Dr Brian Doyle is an emergency physician originally from the United States but now very much calls Tasmania his home. Unfortunately, it will now be a bit more difficult to deport him from the country as he passed his Australian citizenship test a few years ago. (He was able to answer that Phar Lap won the Melbourne rather than the Davis Cup). His main interests are mostly the clinical aspects of emergency medicine but also in education, ultrasound and critical appraisal of the literature. He spends much of his time annoying people to help out with conferences.