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超越ST段抬高型心肌梗死-非ST段抬高型心肌梗死范式:但丁·帕扎内塞对闭塞性心肌梗死诊断的提议

Beyond STEMI-NSTEMI Paradigm: Dante Pazzanese's Proposal for Occlusion Myocardial Infarction Diagnosis.

作者信息

Alencar José Nunes De, Feres Fausto, Marchi Mariana Fuziy Nogueira De, Franchini Kleber Gomes, Scheffer Matheus Kiszka, Felicioni Sandro Pinelli, Costa Ana Carolina Muniz, Fernandes Rinaldo Carvalho, Ramadan Hugo Ribeiro, Meyers Pendell, Smith Stephen W

机构信息

Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil.

Carolinas Medical Center - Department of Emergency Medicine, Charlotte, NC - EUA.

出版信息

Arq Bras Cardiol. 2024 Jul 15;121(5):e20230733. doi: 10.36660/abc.20230733. eCollection 2024.

Abstract

Although the existing framework for classifying acute myocardial infarction (AMI) into STEMI and NSTEMI has been beneficial, it is now considered to be falling short in addressing the complexity of acute coronary syndromes. The study aims to scrutinize the current STEMI-NSTEMI paradigm and advocate for a more nuanced framework, termed as occlusion myocardial infarction (OMI) and non-occlusion myocardial infarction (NOMI), for a more accurate diagnosis and management of AMI. A comprehensive analysis of existing medical literature was conducted, with a focus on the limitations of the STEMI-NSTEMI model. The study also outlines a new diagnostic approach for patients presenting with chest pain in emergency settings. The traditional STEMI-NSTEMI model falls short in diagnostic precision and effective treatment, especially in identifying acute coronary artery occlusions. The OMI-NOMI framework offers a more anatomically and physiologically accurate model, backed by a wealth of clinical research and expert opinion. It underscores the need for quick ECG assessments and immediate reperfusion therapies for suspected OMI cases, aiming to improve patient outcomes. The OMI-NOMI framework offers a new avenue for future research and clinical application. It advocates for a more comprehensive understanding of the underlying mechanisms of acute coronary syndromes, leading to individualized treatment plans. This novel approach is expected to ignite further scholarly debate and research, particularly in the Brazilian cardiology sector, with the goal of enhancing diagnostic accuracy and treatment effectiveness in AMI patients.

摘要

尽管将急性心肌梗死(AMI)分为ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)的现有框架一直很有益,但现在人们认为它在应对急性冠状动脉综合征的复杂性方面存在不足。该研究旨在审视当前的STEMI - NSTEMI范式,并倡导一个更细致入微的框架,即闭塞性心肌梗死(OMI)和非闭塞性心肌梗死(NOMI),以更准确地诊断和管理AMI。对现有医学文献进行了全面分析,重点关注STEMI - NSTEMI模型的局限性。该研究还概述了一种针对急诊中出现胸痛患者的新诊断方法。传统的STEMI - NSTEMI模型在诊断精度和有效治疗方面存在不足,尤其是在识别急性冠状动脉闭塞方面。OMI - NOMI框架提供了一个在解剖学和生理学上更准确的模型,有大量临床研究和专家意见作为支撑。它强调了对疑似OMI病例进行快速心电图评估和立即再灌注治疗的必要性,旨在改善患者预后。OMI - NOMI框架为未来的研究和临床应用提供了一条新途径。它主张对急性冠状动脉综合征的潜在机制有更全面的理解,从而制定个性化的治疗方案。这种新方法有望引发进一步的学术辩论和研究,特别是在巴西心脏病学界,目标是提高AMI患者的诊断准确性和治疗效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/95c9/11216332/82b7fb4a4d55/0066-782X-abc-121-05-e20230733-gf07.jpg

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