de Alencar José Nunes, Helseth Hans, de Assis Henrique Melo, Smith Stephen W
Instituto Dante Pazzanese de Cardiologia, São Paulo 04012-909, SP, Brazil.
Medical College of Wisconsin, Wauwatosa, WI 53226, USA.
Diagnostics (Basel). 2025 Aug 25;15(17):2148. doi: 10.3390/diagnostics15172148.
: Millimetric ST-segment elevation (STEMI) rules miss more than half of angiographic coronary occlusions. Re-casting acute infarction as Occlusion MI (OMI) versus Non-Occlusion MI (NOMI) and embedding that paradigm in Bayesian reasoning could shorten time to reperfusion while limiting unnecessary activations. : We derived age- and sex-specific baseline prevalences of OMI from national emergency-department surveillance data and contemporary angiographic series. Pre-test probabilities were adjusted with published likelihood ratios (LRs) for chest-pain descriptors and clinical risk factors, then updated again with either (1) the stand-alone accuracy of ST-elevation or (2) the pooled accuracy of a broader OMI ECG spectrum. Two decision thresholds were prespecified: post-test probability >10% to trigger catheterization and >75% to justify fibrinolysis when angiography was unavailable. The framework was applied to five consecutive real-world cases that had elicited diagnostic disagreement in clinical practice. : The Bayesian scaffold re-classified three "NSTEMI" tracings as intermediate or high-probability OMI (post-test 27-65%) and prompted immediate reperfusion; each was confirmed as a totally occluded artery. A fourth patient with crushing pain and a normal ECG retained a 17% post-ECG probability and was later found to have an occluded circumflex. The fifth case, an apparent South-African-Flag pattern, initially rose to 75% but fell after a normal bedside echo and normal troponins. : Layering pre-test context with sign-specific LRs transforms ECG interpretation from a binary rule into a transparent probability calculation. The OMI/NOMI Bayesian framework detected occult occlusions that classic STEMI criteria missed.
毫米级ST段抬高型心肌梗死（STEMI）诊断标准会漏诊超过半数的血管造影显示的冠状动脉闭塞。将急性梗死重新定义为闭塞性心肌梗死（OMI）与非闭塞性心肌梗死（NOMI），并将该范式嵌入贝叶斯推理中，可缩短再灌注时间，同时限制不必要的检查。：我们从国家急诊科监测数据和当代血管造影系列中得出了OMI的年龄和性别特异性基线患病率。预测试概率通过已发表的胸痛描述符和临床危险因素的似然比（LRs）进行调整，然后再通过（1）ST段抬高的单独准确性或（2）更广泛的OMI心电图谱的综合准确性进行更新。预先设定了两个决策阈值：检查后概率>10%触发导管插入术，当无法进行血管造影时，>75%证明可进行纤维蛋白溶解。该框架应用于临床实践中引发诊断分歧的连续五个真实病例。：贝叶斯框架将三个“非ST段抬高型心肌梗死（NSTEMI）”心电图重新分类为中度或高概率OMI（检查后概率为27%-65%），并促使立即进行再灌注；每个病例均被确认为动脉完全闭塞。第四例患者有压榨性疼痛且心电图正常，心电图检查后概率仍为17%，后来发现其回旋支闭塞。第五例病例，表面上是南非国旗图案，最初升至75%，但在床边超声心动图正常和肌钙蛋白正常后概率下降。：将预测试背景与体征特异性似然比相结合，将心电图解释从二元规则转变为透明的概率计算。OMI/NOMI贝叶斯框架检测到了经典STEMI标准遗漏的隐匿性闭塞。
