Date of Award


Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)


Physician Assistant Studies

First Advisor

Eric Van Hecke, PA-C, EMCAQ


Acute coronary syndrome (ACS) continues to be the most common cause of death in the United States, and nearly every 34 seconds one American has a coronary event. Based on 12- lead electrocardiogram (ECG) findings myocardial infarction (MI) patients are treated, according to guidelines, emergently with reperfusion therapy if presenting with ST elevation myocardial infarction (STEMI), versus delayed revascularization if presenting with non-ST elevation myocardial infarction (NSTEMI). However, the evidence shows there is a lack of recognition of which patients require immediate catherization utilizing the current guidelines. In recent years, approximately 70% of acute MI (AMI) patients are classified as NSTEMI. Furthermore, it has been observed that approximately 30% of NSTEMI patients have total occluded coronary arteries (TOCA) on angiography yet face a delayed intervention approach that contributes to worsened clinical outcomes.

The current STEMI/NSTEMI paradigm lacks the accuracy in triaging patients who have a suspected acute coronary occlusion (ACO) or near occlusion, with insufficient collateral circulation, whose myocardium is at imminent risk of irreversible infarction without immediate reperfusion. A more recent emerging paradigm to determine who warrants immediate reperfusion is ACO-MI/Non-ACO-MI or Occlusion Myocardial Infarction (OMI) versus Non- Occlusion Myocardial Infarction (NOMI) for short. To answer whether the OMI/NOMI paradigm was superior to STEMI/NSTEMI in evaluating ACS patients, a literature review was conducted primarily utilizing the database PubMed, and certain full-text articles were obtained through Augsburg University’s interlibrary loan system. Overall, literature shows limitations of the current STEMI/NSTEMI paradigm and shows that OMI/NOMI paradigm has superior diagnostic accuracy and earlier recognition abilities for treating patients that present with ACS.


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