STEMI and NSTEMI : the dangerous brothers

With the creation of the NSTEMI as a new clinical entity, the need for data regarding prognosis and treatment options arose. By definition, STEMI and NSTEMI are only different with respect to the reflection of acute myocardial ischaemia and necrosis in the ECG. Although this difference may be triggered by the size of the infarcted area, it may also be only the location of the infarct—an occluded circumflex artery does not project equally well on the ECG as does an occluded right coronary artery. Furthermore, specificity and sensitivity of ECG changes are influenced by several other factors including prior MI, bypass surgery, variation of coronary anatomy, bundle-branch block, and others. Are these differences meaningful—should they lead to different clinical approaches—as the guidelines currently recommend? Are treatment strategies that have been tested before the redefinition of AMI, such as thrombolytic therapy, and that have shown to be beneficial in STEMI and non-beneficial in other acute coronary syndromes applicable to NSTEMI patients? Certainly not without further research.