Cite this post as:
Pendell Meyers. Guest Post – Down with STEMI – The OMI Manifesto by Pendell Meyers. EMCrit Blog. Published on April 1, 2018. Accessed on April 19th 2024. Available at [https://emcrit.org/emcrit/omi-manifesto/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: April 1, 2018
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Thanks Pendell for a great post, explaining the roots of the cognitive dissonance we feel when treating emergent ACS patients. A quick way to present the argument with visuals could be using Venn diagrams- OMI is a big circle, ST elevation is an overlapping circle, STEMI is the (pathological) component of STE that overlaps OMI… Looking down the road, lets pretend that the whole world enthusiastically embraces the OMI paradigm. We would expect that this change, by itself, should improve our ability to select the correct patients for re-perfusion with less false pos/neg etc. How to best protect these gains… Read more »
Thanks for the comment! Unfortunately I think it’s impossible to predict all the possible ways mandates could screw up or impede any attempt at improvement in medicine. I don’t think most people have been able to foresee any of the other legendary mandate blunders in other areas of medicine. The biggest difference between the paradigms is the ECG interpretation step of the algorithms, and the addition of more emphasis on the fact that some clinical features also may mandate emergent angiography. This is not something that can be measured with time, so I don’t think they would be able to… Read more »
Thoroughly enjoyed listening and reading your post. Your concerns are even more crucial for those of us who work in hospitals where we transfer out for CAG/PCI. Quite often the receiving hospital will end up advising us to keep the patient and delayed CAG [treat and return] will be arranged. As you say there is a subgroup in this cohort where there is increased mortality and remaining away from a cardiology centre doesn’t help. Just the other day we had a patient with dynamic changes on his ECG but no STE and a raised troponin who I had similar transfer… Read more »
Thanks for your comment, Ash, glad we could help.
Pendell