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Dr. Smith's ECG Blog

Instructive ECGs in Emergency Medicine Clinical Content

Associate Editors:
— Pendell Meyers & Ken Grauer (2018)
— Jesse McLaren & Emre Aslanger (2022)
— Willy Frick (2024) — Sam Ghali (2025)

editors

OMI Literature Timeline

Occlusion myocardial infarction (OMI) is acute coronary occlusion, or near occlusion, with insufficient collateral flow, whether or not the ECG meets STEMI millimeter criteria. This timeline collects the published evidence behind the shift from the STEMI/NSTEMI paradigm to OMI/NOMI, from the 2018 OMI Manifesto to today. Click a year to expand it. ★ marks a key paper.

New to OMI? Start with these

  1. The OMI Manifesto (2018)
  2. Diagnostic accuracy of electrocardiogram for acute coronary occlusion resulting in myocardial infarction (DIFOCCULT study) (2020)
  3. Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction (2021)
  4. The STEMI/NSTEMI dichotomy needs to be replaced by occlusion MI vs. non-occlusion MI (2021)
  5. Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction (2023)
  6. International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction (2023)
  7. Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion (2024)
  8. From ST-segment elevation MI to occlusion MI: the new paradigm shift in acute myocardial infarction (2024)
  9. Hyperacute T waves are specific for occlusion myocardial infarction, even without diagnostic ST elevation (2025)
  10. AI-enabled ECG analysis improves diagnostic accuracy and reduces false STEMI activations: a multicenter U.S. registry (2025)
  11. Improved detection of acute coronary occlusion myocardial infarction by an artificial intelligence electrocardiogram model in Swedish emergency departments (2026)
  12. Occlusion-focused triage vs very-high-risk NSTEMI criteria: a DIFOCCULT-3 substudy (2026)
20181 entry

  1. ★ The OMI Manifesto

    Meyers HP, Smith SW. Dr. Smith's ECG Blog.

    Blog post

20191 entry

  1. Prospective, real-world evidence showing the gap between ST elevation myocardial infarction (STEMI) and occlusion MI (OMI)

    Meyers HP, Smith SW. International Journal of Cardiology.

    Research

20203 entries

  1. ★ Diagnostic accuracy of electrocardiogram for acute coronary occlusion resulting in myocardial infarction (DIFOCCULT study)

    Aslanger EK, Smith SW, et al. International Journal of Cardiology: Heart & Vasculature.

    Research

  2. Comparison of the STEMI vs. NSTEMI and occlusion MI (OMI) vs. NOMI paradigms of acute MI

    Meyers HP, Bracey A, Smith SW, et al. Journal of Emergency Medicine.

    Research

  3. A new electrocardiographic pattern indicating inferior myocardial infarction (the Aslanger pattern)

    Aslanger E, Yıldırımtürk Ö, Şimşek B, et al. Journal of Electrocardiology 61:41–46.

    Research

202120 entries

  1. Total coronary occlusion in non-ST elevation myocardial infarction: time to change our practice?

    Tziakas D, Chalikias G, Al-Lamee R, Kaski JC. International Journal of Cardiology.

    Commentary

  2. ★ Accuracy of OMI ECG findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction

    Meyers HP, Bracey A, Smith SW, et al. International Journal of Cardiology: Heart & Vasculature.

    Research

  3. STEMI: a transitional fossil in MI classification?

    Aslanger EK, Meyers HP, Smith SW. Journal of Electrocardiology.

    Commentary

  4. Sharing and Teaching of Electrocardiograms to Minimize Infarction (STEMI): reducing diagnostic time for acute coronary occlusion in the emergency department

    McLaren JTT, et al. American Journal of Emergency Medicine.

    Research

  5. Time for a new paradigm shift in myocardial infarction

    Aslanger EK, Meyers HP, Smith SW. Anatolian Journal of Cardiology.

    Commentary

  6. Acute coronary occlusion in non-STEMI: if you change the way you look at things, the things you look at change

    Lopez-de-Sa E. International Journal of Cardiology.

    Commentary

  7. Electrocardiographic diagnosis of acute coronary occlusion myocardial infarction in ventricular paced rhythm using the modified Sgarbossa criteria

    Dodd KW, Meyers HP, Smith SW, et al. Annals of Emergency Medicine.

    Research

  8. ★ The STEMI/NSTEMI dichotomy needs to be replaced by occlusion MI vs. non-occlusion MI

    Aslanger EK, Meyers HP, Bracey A, Smith SW. International Journal of Cardiology.

    Commentary

  9. Of occlusions, inclusions, and exclusions: time to reclassify infarctions?

    Sankardas MA, Ramakumar V, Farooqui FA. Circulation.

    Case report

  10. Recognizing electrocardiographically subtle occlusion myocardial infarction and differentiating it from mimics: ten steps to or away from the cath lab

    Aslanger EK, Meyers HP, Smith SW. Turkish Journal of Cardiology (full text in English and Turkish).

    Review

  11. Improving the ECG diagnosis of the elusive acute coronary occlusion in patients with ventricular paced rhythm

    de Souza IS, Mattu A, Marill KA. Annals of Emergency Medicine.

    Commentary

  12. Rapid diagnosis of STEMI equivalent in patients with left bundle branch block: is it feasible?

    Birnbaum Y, Ye Y, Smith SW, Jneid H. Journal of the American Heart Association.

    Review

  13. Ischemic ST depression maximal in V1–V4 (vs. V5–V6) of any amplitude is specific for occlusion myocardial infarction (vs. non-occlusive ischemia)

    Meyers HP, Bracey A, Smith SW, et al. Journal of the American Heart Association.

    Research

  14. Diagnosis of occlusion myocardial infarction in patients with left bundle branch block and paced rhythms

    Khawaja M, Thakker J, Kherallah R, Ye Y, Smith SW, Birnbaum Y. Current Cardiology Reports.

    Review

  15. From STEMI to occlusion MI: paradigm shift and ED quality improvement

    McLaren JTT, Meyers HP, Smith SW, Chartier LB. Canadian Journal of Emergency Medicine.

    Review

  16. Interobserver variability among experienced electrocardiogram readers to diagnose acute thrombotic coronary occlusion in patients with out-of-hospital cardiac arrest: impact of metabolic and angiographic culprit

    Sharma A, Miranda DF, Rodin H, Bart BA, Smith SW, Shroff GR. Resuscitation.

    Research

  17. Acute occlusion of the infarct-related artery as a predictor of very long-term mortality in patients with acute myocardial infarction

    Kos N, Zeljkovic I, Krcmar T, et al. Cardiology Research and Practice.

    Research

  18. Total occlusion of the infarct-related artery in non-ST-elevation myocardial infarction (NSTEMI): how can we identify these patients?

    Morawska I, et al. Medicina 57(11):1196.

    Article

  19. Low diagnostic yield of ST elevation myocardial infarction amplitude criteria in chest pain patients at the emergency department

    Lindow T, et al. Scandinavian Cardiovascular Journal 55(3):145–152.

    Research

  20. Impact of acute total occlusion of the culprit artery on outcome in NSTEMI based on the results of a large national registry

    Terlecki M, Wojciechowska W, Dudek D, et al. BMC Cardiovascular Disorders 21:297.

    Research

20226 entries

  1. Point-of-care ultrasound may expedite diagnosis and revascularization of occult occlusive myocardial infarction

    Xu C, et al. American Journal of Emergency Medicine.

    Case report

  2. Emerging ECG methods for acute coronary syndrome detection: recommendations and future opportunities

    Al-Zaiti S, Macleod R, Van Dam P, Smith SW, Birnbaum Y. Journal of Electrocardiology.

    Review

  3. From Q/non-Q myocardial infarction to STEMI/NSTEMI: why it's time to consider another simplified dichotomy; a narrative literature review

    Avdikos G, Michas G, Smith SW. Archives of Academic Emergency Medicine 10(1):e78.

    Review

  4. 2022 ACC Expert Consensus Decision Pathway on the evaluation and disposition of acute chest pain in the emergency department

    Kontos MC, et al. Journal of the American College of Cardiology.

    Guideline

  5. Acute coronary occlusion in a patient with prior known right bundle branch block: another chink in the armor for the STEMI criteria

    Triska J, George J, Rector G, Alam M, Smith SW, Meyers HP, Birnbaum Y. Annals of Emergency Medicine.

    Case report

  6. Treatment time and in-hospital mortality among patients with ST-segment elevation myocardial infarction, 2018–2021

    Jollis JG, et al. JAMA 328(20):2033–2040.

    Research

202320 entries

  1. Occluded coronary artery among non-ST elevation myocardial infarction patients in a tertiary care centre: a descriptive cross-sectional study

    Sharma M, et al. Journal of the Nepal Medical Association 61(257):54–58.

    Research

  2. Proposed new classification for acute coronary syndrome: acute coronary syndrome requiring immediate reperfusion

    Zoni CR, Mukherjee D, Gulati M. Catheterization and Cardiovascular Interventions 101(7):1177–1181.

    Commentary

  3. Hyperacute T-waves can be a useful sign of occlusion myocardial infarction if appropriately defined

    Meyers HP, Smith SW. Annals of Emergency Medicine.

    Letter

  4. What should ECG deep learning focus on? The diagnosis of acute coronary occlusion! (Kenichi Harumi Plenary Address, ISCE)

    McLaren JTT, Meyers HP, Smith SW. Journal of Electrocardiology.

    ReviewAI

  5. Acute coronary occlusion in patients with non-ST-segment elevation out-of-hospital cardiac arrest

    Spirito A, et al. Journal of the American College of Cardiology 81(5):446–456.

    Research

  6. Clinical implication of totally occluded infarct-related coronary artery in non-ST-segment elevation myocardial infarction: the TOTAL-NSTEMI study

    Guener et al. Coronary Artery Disease 34(2):127–133.

    Research

  7. Chest pain, paced rhythm, and 2 missed indications for emergent reperfusion

    McLaren JTT, Meyers HP, Smith SW. JAMA Internal Medicine.

    Case report

  8. Beyond the ST-segment in occlusion myocardial infarction (OMI): diagnosing the OMI-nous

    Aslanger EK. Turkish Journal of Emergency Medicine 23(1):1–4.

    Review

  9. Occlusive myocardial infarction: emerging paradigm of acute coronary syndromes

    Rolek B, et al. Advances in Interventional Cardiology.

    Review

  10. ★ Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction

    Al-Zaiti SS, et al. Nature Medicine.

    ResearchAI

  11. Missing occlusions: quality gaps for ED patients with occlusion MI

    McLaren JTT, El-Baba M, Sivashanmugathas V, Meyers HP, Smith SW, Chartier LB. American Journal of Emergency Medicine.

    Research

  12. Emergency department code STEMI patients with initial ECG labelled 'normal' by computer interpretation: a 7-year retrospective review

    McLaren JTT, Meyers HP, Smith SW, Chartier LB. Academic Emergency Medicine.

    Research

  13. Is it time for a paradigm shift towards occlusion myocardial infarction?

    Muthyala A, Sasidharan S, Shringi S, et al. JSCAI.

    Review

  14. Comparison of diagnostic accuracy of current left bundle branch block and ventricular pacing ECG criteria for detection of occlusion myocardial infarction

    Lindow T, Mokhtari A, Nyström A, Koul S, Smith SW, Ekelund U. International Journal of Cardiology.

    Research

  15. ★ International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction

    Herman R, Meyers HP, Smith SW, et al. European Heart Journal – Digital Health.

    ResearchQueen of Hearts

  16. ECG-based deep learning for detecting epicardial coronary occlusion in acute myocardial infarction

    Herman R, Meyers HP, Smith SW. European Heart Journal 44(Suppl 2).

    AbstractQueen of Hearts

  17. Shark fin occlusive myocardial infarction ECG pattern post-cardiac arrest misinterpreted as ventricular tachycardia

    Escabi-Mendoza J, Diaz-Rodriguez P, Silva-Cantillo R. Cureus 15(5):e38708.

    Case report

  18. Why do we keep missing left circumflex artery myocardial infarctions?

    Geffin R, Triska J, Najjar S, Berman J, Cruse M, Birnbaum Y. Journal of Electrocardiology.

    Review

  19. Applying Bayesian reasoning to electrocardiogram interpretation

    de Alencar JN. Journal of Electrocardiology 81:295–299.

    Review

  20. Poor prognosis of total culprit artery occlusion in patients presenting with NSTEMI

    European Heart Journal (ESC Congress 2023 abstract).

    Abstract

202426 entries

  1. Acute coronary occlusion with vs. without ST-elevation: impact on procedural outcomes and long-term all-cause mortality

    Abusharekh M, Kampf J, Dykun I, et al. European Heart Journal – Quality of Care and Clinical Outcomes.

    Research

  2. ★ Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion

    de Alencar Neto JN, Scheffer MK, Correia BP, et al. International Journal of Cardiology.

    Research

  3. ST elevation is a poor surrogate for acute coronary occlusion. Let's replace STEMI with occlusion MI (OMI)!

    Smith SW, Meyers HP. International Journal of Cardiology.

    Commentary

  4. Beyond the STEMI-NSTEMI paradigm: Instituto Dante Pazzanese's proposal for occlusion myocardial infarction diagnosis

    de Alencar JN, Feres F, Marchi M, et al. Arquivos Brasileiros de Cardiologia.

    Review

  5. Single center retrospective validation of an artificial intelligence ECG model detecting acute coronary occlusion

    Frick W, Atallah I, Saraf R, et al. Heart Rhythm Society 2024, Boston. Blog summary

    AbstractQueen of Hearts

  6. Computer-interpreted electrocardiograms: impact on cardiology practice

    Gupta S, Kashou AH, Herman R, et al. International Journal of Cardiovascular Sciences 37.

    ReviewAI

  7. Clinical usability of deep learning-based saliency maps for occlusion myocardial infarction identification from the prehospital 12-lead electrocardiogram

    Riek NT, Gokhale TA, Martin-Gill C, et al. Journal of Electrocardiology.

    ResearchAI

  8. The no false negative paradox in STEMI-NSTEMI diagnosis

    de Alencar JN, Meyers HP, McLaren JTT, Smith SW. Heart (BMJ).

    Commentary

  9. OMI/NOMI: time for a new classification of acute myocardial infarction

    Kola M, Shuka N, Meyers HP, Zaima E, Smith SW. Journal of Clinical Medicine 13:5201.

    Review

  10. Artificial intelligence driven prehospital ECG interpretation for the reduction of false positive emergent cardiac catheterization lab activations: a retrospective cohort study

    Baker PO, Shifa KR, Smith SW, et al. Prehospital Emergency Care.

    ResearchQueen of Hearts

  11. Performance of artificial intelligence powered ECG analysis in suspected ST-segment elevation myocardial infarction

    Sharkey S, Herman R, Larson D, et al. AHA Scientific Sessions 2024, Chicago.

    AbstractQueen of Hearts

  12. Expertise in ECG interpretation and artificial intelligence ECG models for occlusion myocardial infarction diagnosis

    Avdikos G. Japan Journal of Research 5(10):74.

    ReviewAI

  13. SCAI expert consensus statement on the management of patients with STEMI referred for primary PCI

    Tamis-Holland JE, Abbott JD, Al-Azizi K, et al. JSCAI.

    Guideline

  14. ★ From ST-segment elevation MI to occlusion MI: the new paradigm shift in acute myocardial infarction

    McLaren JTT, de Alencar JN, Aslanger EK, Meyers HP, Smith SW. JACC: Advances.

    Review

  15. Female patients with occlusive myocardial infarction without ST elevation experience longer delays in receiving emergent reperfusion

    Kisova T, Herman R, Demolder A, et al. Circulation 150(Suppl 1).

    Abstract

  16. Deep-learning assisted ECG-based emergent cath lab activation: first prospective implementation of a smartphone-based system

    Herman R, Lauwers R, Pletinckx D, et al. Circulation 150(Suppl 1).

    AbstractQueen of Hearts

  17. AI-enhanced recognition of occlusion in acute coronary syndrome (AERO-ACS): a retrospective review

    Choi J, Torelli V, Diaz S, et al. Circulation 150(Suppl 1).

    AbstractQueen of Hearts

  18. Artificial intelligence tool accurately predicts occlusion myocardial infarction and may reduce false-positive cath lab activations

    Harris S, Brown F, May A, Bach R. Circulation 150(Suppl 1).

    AbstractQueen of Hearts

  19. Implementing artificial intelligence for electrocardiogram interpretation: a case study

    Bradshaw JC, Nagourney E, Warshel M, Weygandt PL. JEM Reports.

    Case reportQueen of Hearts

  20. Ep 121: OMI/NOMI: a paradigm shift in myocardial infarction diagnosis

    Smith SW with Ankur Kalra. Parallax Podcast, Oct 21, 2024.

    Podcast

  21. This Week in Cardiology (OMI/NOMI discussion starts at 6:30)

    John Mandrola. Medscape podcast, Oct 11, 2024.

    Podcast

  22. Does ST elevation MI need a rebrand to 'occlusion MI'?

    Harrington RA, Patel MR, Gibson CM. The Bob Harrington Show, Medscape, Dec 10, 2024.

    Podcast

  23. Artificial intelligence-based detection of occlusion myocardial infarction: first external validation in a German chest-pain unit cohort

    Macherey-Meyer S, Meyers HP, Smith SW, et al. Clinical Research in Cardiology (DGK 2024 abstract).

    AbstractQueen of Hearts

  24. Prevalence and predictors of occlusive myocardial infarction in patients presenting with non-ST-elevation acute coronary syndrome in Duhok, Iraq: a cross-sectional study

    Mohammad AM, Ali MM. Cureus 16(7):e65299.

    Research

  25. Application of the artificial intelligence model for detection of electrocardiographic signs of coronary occlusion in patients with non-ST-elevation acute coronary syndrome

    Ukrainian Journal of Cardiovascular Surgery.

    ResearchQueen of Hearts

  26. Evaluating AI prediction of occlusive myocardial infarction from 12-lead ECGs after resuscitated out-of-hospital cardiac arrest

    Journal of the American College of Cardiology (abstract).

    AbstractQueen of Hearts

202537 entries

  1. Artificial intelligence-powered electrocardiogram detecting culprit vessel blood flow abnormality: AI-ECG TIMI study design and rationale

    Herman R, Kisova T, Belmonte M, et al. JSCAI.

    ResearchQueen of Hearts

  2. ECG patterns of occlusion myocardial infarction: a narrative review

    Ricci F, Martini C, Scordo DM, et al. Annals of Emergency Medicine 85(4):330–340.

    Review

  3. The crucial role of image quality in AI-enabled ECG digitization and interpretation of occlusion myocardial infarction

    Herman R, Smith SW. Journal of Electrocardiology 89:153873.

    CommentaryQueen of Hearts

  4. Reply: Occlusion myocardial infarction: from theoretical concept to practical therapy

    McLaren JTT, de Alencar JN, Aslanger EK, Meyers HP, Smith SW. JACC: Advances 4(2):101550.

    Letter

  5. Identifying equity gaps in the diagnosis and treatment of occlusion myocardial infarction

    Sivashanmugathas V, El-Baba M, Jones MK, et al. CJC Open 7(5):632–640.

    Research

  6. What is the gold standard for ECG interpretation: computer, cardiologist, or patient outcome?

    McLaren JTT, Kennedy CA, Meyers HP, Smith SW, Chartier LB. Canadian Journal of Emergency Medicine.

    Commentary

  7. Artificial intelligence detection of occlusive myocardial infarction from electrocardiograms interpreted as “normal” by conventional algorithms

    Karim SR, Helseth HC, Baker PO, et al. Journal of Personalized Medicine 15(4):130.

    ResearchQueen of Hearts

  8. Failure of standard contemporary ST-elevation myocardial infarction electrocardiogram criteria to reliably identify acute coronary occlusion of the left anterior descending coronary artery

    Meyers HP, Sharkey SW, Herman R, et al. European Heart Journal: Acute Cardiovascular Care.

    ResearchQueen of Hearts

  9. STEMI critics are right: we're missing too many heart attacks

    Bivens M. Emergency Medicine News 47(3).

    Commentary

  10. Reevaluating STEMI: the utility of the occlusive myocardial infarction classification to enhance management of acute coronary syndromes

    Ayyad M, Albandak M, Gala D, et al. Current Cardiology Reports 27:75.

    Review

  11. Precordial swirl sign: a new ECG pattern of left anterior descending artery occlusion myocardial infarction

    Goss L, Meyers HP, Friedman B, Bracey A, Smith SW. Journal of Electrocardiology 91:153931.

    Research

  12. Impact of acute total occlusion of the culprit vessel on prognosis and risk stratification in patients with non-ST-segment elevation myocardial infarction

    Yu Q, et al. American Journal of Cardiology.

    Research

  13. Beyond STEMI: high-risk ECG patterns as predictors of occlusive myocardial infarction in out-of-hospital cardiac arrest patients

    Silwanus C, et al. Resuscitation.

    Research

  14. Occlusion myocardial infarction and artificial intelligence: a perspective on out-of-hospital ECG interpretation

    Bishop AJ, Meadley BN. Paramedicine.

    CommentaryAI

  15. Door-to-balloon time outperforms ST-segment elevation in predicting the STEMI vs. NSTEMI final diagnosis

    de Alencar JN, Meyers HP, Frick WH, McLaren JTT, Smith SW. Journal of Clinical Medicine 14:6588.

    Research

  16. Comparison of regional wall motion abnormalities in patients with occlusion myocardial infarction with and without ST-elevation myocardial infarction (STEMI)

    Bracey A, Meyers HP, Watkins C, et al. Clinical and Experimental Emergency Medicine 12(4):342–349.

    Research

  17. ★ Hyperacute T waves are specific for occlusion myocardial infarction, even without diagnostic ST elevation

    Meyers HP, Simancik F, Herman R, et al. JACC: Advances.

    Research

  18. First objective definition of hyperacute T waves as an ST-segment elevation myocardial infarction equivalent ECG finding

    Meyers HP, Simancik F, Herman R, et al. Journal of the American College of Cardiology 85(12 Suppl):1946.

    AbstractQueen of Hearts

  19. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: physicians vs. AI (PMcardio Queen of Hearts)

    Shroyer S, Mehta S, Thukral N, et al. American Journal of Emergency Medicine.

    ResearchQueen of Hearts

  20. Thrombolysis in non-ST-elevation myocardial infarction: systematic review and meta-analysis of randomised controlled trials

    de Alencar JN, Oliveira MHJ, Bulhões E, et al. Open Heart 12:e003700.

    Research

  21. Every minute of delay (still) counts!

    Dziewierz A, De Luca G, Rakowski T. Advances in Interventional Cardiology.

    CommentaryQueen of Hearts

  22. ★ AI-enabled ECG analysis improves diagnostic accuracy and reduces false STEMI activations: a multicenter U.S. registry

    Herman R, Mumma B, Hoyne J, et al. JACC: Cardiovascular Interventions.

    ResearchQueen of Hearts

  23. Artificial intelligence based detection of acute coronary occlusion compared to STEMI criteria: external validation study in a consecutive all-comer German chest pain unit cohort

    Macherey-Meyer S, Meyers HP, et al. Clinical Research in Cardiology (DGK 2025 abstract).

    AbstractQueen of Hearts

  24. Artificial intelligence-assisted, ECG-based triage of patients with chest pain to immediate invasive treatment: initial validation in a German all-comers chest pain unit cohort

    Macherey-Meyer S, Meertens MM, Heyne S, et al. Deutsches Ärzteblatt International.

    ResearchQueen of Hearts

  25. Artificial intelligence-enhanced ECG detection of acute coronary occlusion in chest pain patients with ST-elevation in lead aVR: a direct comparison to conventional ECG criteria

    Terporten J, Meertens MM, Heyne S, et al. European Heart Journal: Acute Cardiovascular Care.

    ResearchQueen of Hearts

  26. AI-enhanced recognition of occlusions in acute coronary syndrome (AERO-ACS): a retrospective study

    Choi JWH, Torelli V, Silverman A, et al. Coronary Artery Disease.

    ResearchQueen of Hearts

  27. Artificial intelligence versus human expertise: ECG-based detection of occlusive myocardial infarction after cardiac arrest

    Silwanis C, Eder J, Fellner A, et al. Resuscitation.

    ResearchQueen of Hearts

  28. An artificial intelligence model for electrocardiogram detection of occlusion myocardial infarction: a retrospective study to reduce false-positive cath lab activations

    Cooper BL, Genova EA, Bakunas CA, et al. European Heart Journal – Digital Health.

    ResearchQueen of Hearts

  29. »Occlusion Myocardial Infarction« (OMI): a new classification proposed to improve detection beyond strict STEMI criteria [in Swedish]

    Lindow T, Pahlm O, Mokhtari A, Koul S, Hammarlund P, Ekelund U. Läkartidningen 122:25041.

    Review

  30. Occlusion myocardial infarction: a revolution in acute coronary syndrome

    Frick WH, McLaren JTT, Meyers HP, Smith SW. Advances in Interventional Cardiology 21(2):139–143.

    Commentary

  31. Bayesian diagnosis of occlusion myocardial infarction: a case-based clinical analysis

    de Alencar JN, Helseth H, Melo de Assis H, Smith SW. Diagnostics 15(17):2148.

    Research

  32. A diagnostic paradigm shift in acute myocardial infarction: rationale and design of the DIFOCCULT-3 trial

    Aslanger EK, Aggul B, Yildirimturk O, et al. JACC: Advances 4:102227.

    Research

  33. Occlusion myocardial infarction: a paradigm ready for clinical application

    Orvostudományi Értesítő.

    Review

  34. Derivation of an artificial intelligence-based electrocardiographic model for the detection of acute coronary occlusive myocardial infarction

    Diaz-Herrera BA, Roman-Rangel E, Castro-Garcia CA, et al. Archivos de Cardiología de México 95:178–187.

    ResearchAI

  35. Missed occlusions: diagnostic accuracy of ECG STEMI criteria for identifying occlusive myocardial infarction. A systematic review and meta-analysis

    Costantini I, Breglia A, Pilav M, Zanatta M, Ventura MV, Ricci G. Emergency Care Journal 21(4).

    Research

  36. Association between artificial intelligence detected features on the ECG and presence of microvascular obstruction

    Circulation: Cardiovascular Interventions.

    ResearchQueen of Hearts

  37. Bifascicular block associated with myocardial infarction: a marker of proximal left anterior descending artery occlusion confirmed by the artificial intelligence-based smartphone app Queen of Hearts

    Cureus.

    Case reportQueen of Hearts

202627 entries

  1. Prognostic significance of the discrepancy between the STEMI/NSTEMI paradigm and the angiographically confirmed diagnosis of occlusion myocardial infarction: a retrospective cohort study

    Terlecki M, Meyers HP, Smith SW, et al. Heliyon.

    Research

  2. Predicting occlusion myocardial infarctions in the emergency department using artificial intelligence

    Nyström A, Björkelund A, Wagner H, et al. JACEP Open 7(1):100299.

    ResearchAI

  3. Performance of artificial intelligence powered ECG analysis in suspected ST-segment elevation myocardial infarction

    Sharkey SW, Herman R, Witt DR, et al. JACC: Advances.

    ResearchQueen of Hearts

  4. Detecting occlusion myocardial infarction with an AI-powered ECG model: a retrospective cohort study

    Hellerman MB, Wang C, Zhang DT, Kalogeropoulos AP, Skopicki HA. Journal of Personalized Medicine 16(4):174.

    ResearchQueen of Hearts

  5. AI-enhanced electrocardiogram for detection of occlusive myocardial infarction in high-risk non-ST-segment elevation acute coronary syndrome

    Carvalho PEP, Belzer W, Pollmann DL, et al. JACC: Advances.

    ResearchQueen of Hearts

  6. A deep learning ECG model for identification and localization of occlusion myocardial infarction

    Gustafsson S, Ribeiro AH, et al. Nature Communications 17:4336.

    ResearchAI

  7. Can an AI ECG algorithm improve diagnostic accuracy for acute coronary occlusion in the difficult subset of canceled catheterization lab activations?

    Friedman BS, Malloy-Post R, Smith SW, Meyers HP. Journal of Electrocardiology.

    ResearchQueen of Hearts

  8. Independent retrospective evaluation of an artificial intelligence-guided pathway for rapid identification of acute coronary occlusion in emergency department patients

    Eller BL, Radey OA, Inslee AK, et al. The Journal of Precision Medicine: Health and Disease.

    ResearchQueen of Hearts

  9. AI-STEMI: can artificial intelligence outperform humans in detecting coronary occlusions?

    Zimmerli A, Dupre M, Liabot Q, et al. Journal of Medical Internet Research.

    ResearchQueen of Hearts

  10. Specificity of the occlusion myocardial infarction-trained PMcardio “Queen of Hearts” AI-ECG in inflammatory myopericardial syndromes: a comparison with guideline criteria and large language models

    Bennar W, et al. JACC: Advances 5(8):103046.

    ResearchQueen of Hearts

  11. ECG-based detection of occlusion myocardial infarction: a dedicated deep neural network versus multimodal large language models and physicians, a retrospective diagnostic accuracy study

    Akar EH, Kokulu K, Sert ET. BMC Emergency Medicine 26:237.

    ResearchQueen of Hearts

  12. ★ Improved detection of acute coronary occlusion myocardial infarction by an artificial intelligence electrocardiogram model in Swedish emergency departments

    Lindow T, Nyström A, Forberg JL, et al. JACEP Open 7(5):100473.

    ResearchQueen of Hearts

  13. Bringing artificial intelligence to the front lines: PMcardio for detecting occlusive myocardial infarction in STEMI and STEMI-equivalent activations

    Bahrou M, Missula K, Amadi T, Cheema A, Siddique M. International Journal for Quality in Health Care.

    ResearchQueen of Hearts

  14. Editorial commentary: the emerging paradigm of occlusion myocardial infarction in acute coronary syndromes

    Ayyad M. Trends in Cardiovascular Medicine 36(3):188–189.

    Commentary

  15. Acute coronary-occlusion myocardial infarctions: performance of the STEMI criteria and evolving alternative approaches

    Trends in Cardiovascular Medicine 36(3):180–187.

    Review

  16. Diagnosis of occlusion myocardial infarction

    McLaren JTT, Nunes de Alencar J, Smith SW. Current Opinion in Critical Care 32(3):230–238.

    Review

  17. Occlusion myocardial infarction in patients with non-ST-segment elevation myocardial infarction and its correlation with electrocardiography: a prospective observational study

    Journal of Primary Care Specialties 7(2):87–92.

    Research

  18. Occlusive myocardial infarction: a practical review of STEMI-negative coronary occlusion in acute coronary syndromes

    Mashiah G, Elbassel R, Zornitzki L. Medicina 62(10):1843.

    Review

  19. Angiographic prevalence of occlusion myocardial infarction and the limited value of serial troponin in patients with non-ST-segment elevation acute coronary syndrome

    Kadir S, Sasidharan S, Shringi S, Dasari M, Arun Kumar P. Frontiers in Cardiovascular Medicine 13.

    Research

  20. Acute coronary occlusion in NSTEMI patients: prevalence, clinical characteristics and the potential role of artificial intelligence

    Stathakopoulou C, Varlamos C, Butt H, et al. Medicina 62:899.

    Research

  21. Artificial intelligence-enhanced electrocardiography for acute myocardial infarction detection: a systematic review

    Lee Y, Ahn JH, Yang HM. Cardiovascular Diagnosis and Therapy 16:30.

    ReviewAI

  22. Evidence for electrocardiographic patterns identifying acute coronary occlusion in non-ST-elevation acute coronary syndromes: a scoping review

    Academic Emergency Medicine.

    Review

  23. Prevalence and early left ventricular outcomes of occlusive myocardial infarction in non-ST-elevation acute coronary syndrome: a retrospective observational study

    Cureus.

    Research

  24. Chest pain with subtle but lifesaving ECG findings

    Annals of Emergency Medicine.

    Case report

  25. ★ Occlusion-focused triage vs very-high-risk NSTEMI criteria: a DIFOCCULT-3 substudy

    Aslanger EK, …, Değertekin M. JACC: Cardiovascular Interventions.

    Research

  26. Acute coronary occlusions in NSTEMI undergoing percutaneous coronary intervention: insights from the CathPCI Registry

    Kherallah RY, …, Denktas AA. JACC: Cardiovascular Interventions.

    Research

  27. Frequency and prognosis of alternative definitions of occlusion myocardial infarction across the whole spectrum of acute coronary syndromes

    Milzi A, …, Valgimigli M. JACC: Cardiovascular Interventions.

    Research

AI research on OMI

Studies of AI ECG models for detecting occlusion MI, also tagged in the timeline above.

Queen of Hearts (PMcardio) studies

  1. International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction

    Herman R, Meyers HP, Smith SW, et al. European Heart Journal – Digital Health 2023.

    Research

  2. ECG-based deep learning for detecting epicardial coronary occlusion in acute myocardial infarction

    Herman R, Meyers HP, Smith SW. European Heart Journal 44(Suppl 2) 2023.

    Abstract

  3. Single center retrospective validation of an artificial intelligence ECG model detecting acute coronary occlusion

    Frick W, Atallah I, Saraf R, et al. Heart Rhythm Society 2024, Boston 2024. Blog summary

    Abstract

  4. Artificial intelligence driven prehospital ECG interpretation for the reduction of false positive emergent cardiac catheterization lab activations: a retrospective cohort study

    Baker PO, Shifa KR, Smith SW, et al. Prehospital Emergency Care 2024.

    Research

  5. Performance of artificial intelligence powered ECG analysis in suspected ST-segment elevation myocardial infarction

    Sharkey S, Herman R, Larson D, et al. AHA Scientific Sessions 2024, Chicago 2024.

    Abstract

  6. Deep-learning assisted ECG-based emergent cath lab activation: first prospective implementation of a smartphone-based system

    Herman R, Lauwers R, Pletinckx D, et al. Circulation 150(Suppl 1) 2024.

    Abstract

  7. AI-enhanced recognition of occlusion in acute coronary syndrome (AERO-ACS): a retrospective review

    Choi J, Torelli V, Diaz S, et al. Circulation 150(Suppl 1) 2024.

    Abstract

  8. Artificial intelligence tool accurately predicts occlusion myocardial infarction and may reduce false-positive cath lab activations

    Harris S, Brown F, May A, Bach R. Circulation 150(Suppl 1) 2024.

    Abstract

  9. Implementing artificial intelligence for electrocardiogram interpretation: a case study

    Bradshaw JC, Nagourney E, Warshel M, Weygandt PL. JEM Reports 2024.

    Case report

  10. Artificial intelligence-based detection of occlusion myocardial infarction: first external validation in a German chest-pain unit cohort

    Macherey-Meyer S, Meyers HP, Smith SW, et al. Clinical Research in Cardiology (DGK 2024 abstract) 2024.

    Abstract

  11. Application of the artificial intelligence model for detection of electrocardiographic signs of coronary occlusion in patients with non-ST-elevation acute coronary syndrome

    Ukrainian Journal of Cardiovascular Surgery 2024.

    Research

  12. Evaluating AI prediction of occlusive myocardial infarction from 12-lead ECGs after resuscitated out-of-hospital cardiac arrest

    Journal of the American College of Cardiology (abstract) 2024.

    Abstract

  13. Artificial intelligence-powered electrocardiogram detecting culprit vessel blood flow abnormality: AI-ECG TIMI study design and rationale

    Herman R, Kisova T, Belmonte M, et al. JSCAI 2025.

    Research

  14. The crucial role of image quality in AI-enabled ECG digitization and interpretation of occlusion myocardial infarction

    Herman R, Smith SW. Journal of Electrocardiology 89:153873 2025.

    Commentary

  15. Artificial intelligence detection of occlusive myocardial infarction from electrocardiograms interpreted as “normal” by conventional algorithms

    Karim SR, Helseth HC, Baker PO, et al. Journal of Personalized Medicine 15(4):130 2025.

    Research

  16. Failure of standard contemporary ST-elevation myocardial infarction electrocardiogram criteria to reliably identify acute coronary occlusion of the left anterior descending coronary artery

    Meyers HP, Sharkey SW, Herman R, et al. European Heart Journal: Acute Cardiovascular Care 2025.

    Research

  17. First objective definition of hyperacute T waves as an ST-segment elevation myocardial infarction equivalent ECG finding

    Meyers HP, Simancik F, Herman R, et al. Journal of the American College of Cardiology 85(12 Suppl):1946 2025.

    Abstract

  18. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: physicians vs. AI (PMcardio Queen of Hearts)

    Shroyer S, Mehta S, Thukral N, et al. American Journal of Emergency Medicine 2025.

    Research

  19. Every minute of delay (still) counts!

    Dziewierz A, De Luca G, Rakowski T. Advances in Interventional Cardiology 2025.

    Commentary

  20. AI-enabled ECG analysis improves diagnostic accuracy and reduces false STEMI activations: a multicenter U.S. registry

    Herman R, Mumma B, Hoyne J, et al. JACC: Cardiovascular Interventions 2025.

    Research

  21. Artificial intelligence based detection of acute coronary occlusion compared to STEMI criteria: external validation study in a consecutive all-comer German chest pain unit cohort

    Macherey-Meyer S, Meyers HP, et al. Clinical Research in Cardiology (DGK 2025 abstract) 2025.

    Abstract

  22. Artificial intelligence-assisted, ECG-based triage of patients with chest pain to immediate invasive treatment: initial validation in a German all-comers chest pain unit cohort

    Macherey-Meyer S, Meertens MM, Heyne S, et al. Deutsches Ärzteblatt International 2025.

    Research

  23. Artificial intelligence-enhanced ECG detection of acute coronary occlusion in chest pain patients with ST-elevation in lead aVR: a direct comparison to conventional ECG criteria

    Terporten J, Meertens MM, Heyne S, et al. European Heart Journal: Acute Cardiovascular Care 2025.

    Research

  24. AI-enhanced recognition of occlusions in acute coronary syndrome (AERO-ACS): a retrospective study

    Choi JWH, Torelli V, Silverman A, et al. Coronary Artery Disease 2025.

    Research

  25. Artificial intelligence versus human expertise: ECG-based detection of occlusive myocardial infarction after cardiac arrest

    Silwanis C, Eder J, Fellner A, et al. Resuscitation 2025.

    Research

  26. An artificial intelligence model for electrocardiogram detection of occlusion myocardial infarction: a retrospective study to reduce false-positive cath lab activations

    Cooper BL, Genova EA, Bakunas CA, et al. European Heart Journal – Digital Health 2025.

    Research

  27. Association between artificial intelligence detected features on the ECG and presence of microvascular obstruction

    Circulation: Cardiovascular Interventions 2025.

    Research

  28. Bifascicular block associated with myocardial infarction: a marker of proximal left anterior descending artery occlusion confirmed by the artificial intelligence-based smartphone app Queen of Hearts

    Cureus 2025.

    Case report

  29. Performance of artificial intelligence powered ECG analysis in suspected ST-segment elevation myocardial infarction

    Sharkey SW, Herman R, Witt DR, et al. JACC: Advances 2026.

    Research

  30. Detecting occlusion myocardial infarction with an AI-powered ECG model: a retrospective cohort study

    Hellerman MB, Wang C, Zhang DT, Kalogeropoulos AP, Skopicki HA. Journal of Personalized Medicine 16(4):174 2026.

    Research

  31. AI-enhanced electrocardiogram for detection of occlusive myocardial infarction in high-risk non-ST-segment elevation acute coronary syndrome

    Carvalho PEP, Belzer W, Pollmann DL, et al. JACC: Advances 2026.

    Research

  32. Can an AI ECG algorithm improve diagnostic accuracy for acute coronary occlusion in the difficult subset of canceled catheterization lab activations?

    Friedman BS, Malloy-Post R, Smith SW, Meyers HP. Journal of Electrocardiology 2026.

    Research

  33. Independent retrospective evaluation of an artificial intelligence-guided pathway for rapid identification of acute coronary occlusion in emergency department patients

    Eller BL, Radey OA, Inslee AK, et al. The Journal of Precision Medicine: Health and Disease 2026.

    Research

  34. AI-STEMI: can artificial intelligence outperform humans in detecting coronary occlusions?

    Zimmerli A, Dupre M, Liabot Q, et al. Journal of Medical Internet Research 2026.

    Research

  35. Specificity of the occlusion myocardial infarction-trained PMcardio “Queen of Hearts” AI-ECG in inflammatory myopericardial syndromes: a comparison with guideline criteria and large language models

    Bennar W, et al. JACC: Advances 5(8):103046 2026.

    Research

  36. ECG-based detection of occlusion myocardial infarction: a dedicated deep neural network versus multimodal large language models and physicians, a retrospective diagnostic accuracy study

    Akar EH, Kokulu K, Sert ET. BMC Emergency Medicine 26:237 2026.

    Research

  37. Improved detection of acute coronary occlusion myocardial infarction by an artificial intelligence electrocardiogram model in Swedish emergency departments

    Lindow T, Nyström A, Forberg JL, et al. JACEP Open 7(5):100473 2026.

    Research

  38. Bringing artificial intelligence to the front lines: PMcardio for detecting occlusive myocardial infarction in STEMI and STEMI-equivalent activations

    Bahrou M, Missula K, Amadi T, Cheema A, Siddique M. International Journal for Quality in Health Care 2026.

    Research

Other AI models and commentary

  1. What should ECG deep learning focus on? The diagnosis of acute coronary occlusion! (Kenichi Harumi Plenary Address, ISCE)

    McLaren JTT, Meyers HP, Smith SW. Journal of Electrocardiology 2023.

    Review

  2. Machine learning for ECG diagnosis and risk stratification of occlusion myocardial infarction

    Al-Zaiti SS, et al. Nature Medicine 2023.

    Research

  3. Computer-interpreted electrocardiograms: impact on cardiology practice

    Gupta S, Kashou AH, Herman R, et al. International Journal of Cardiovascular Sciences 37 2024.

    Review

  4. Clinical usability of deep learning-based saliency maps for occlusion myocardial infarction identification from the prehospital 12-lead electrocardiogram

    Riek NT, Gokhale TA, Martin-Gill C, et al. Journal of Electrocardiology 2024.

    Research

  5. Expertise in ECG interpretation and artificial intelligence ECG models for occlusion myocardial infarction diagnosis

    Avdikos G. Japan Journal of Research 5(10):74 2024.

    Review

  6. Occlusion myocardial infarction and artificial intelligence: a perspective on out-of-hospital ECG interpretation

    Bishop AJ, Meadley BN. Paramedicine 2025.

    Commentary

  7. Derivation of an artificial intelligence-based electrocardiographic model for the detection of acute coronary occlusive myocardial infarction

    Diaz-Herrera BA, Roman-Rangel E, Castro-Garcia CA, et al. Archivos de Cardiología de México 95:178–187 2025.

    Research

  8. Predicting occlusion myocardial infarctions in the emergency department using artificial intelligence

    Nyström A, Björkelund A, Wagner H, et al. JACEP Open 7(1):100299 2026.

    Research

  9. A deep learning ECG model for identification and localization of occlusion myocardial infarction

    Gustafsson S, Ribeiro AH, et al. Nature Communications 17:4336 2026.

    Research

  10. Artificial intelligence-enhanced electrocardiography for acute myocardial infarction detection: a systematic review

    Lee Y, Ahn JH, Yang HM. Cardiovascular Diagnosis and Therapy 16:30 2026.

    Review

Trials in progress

Registered prospective studies testing the OMI paradigm and AI-assisted OMI detection. Click a trial for its current status on ClinicalTrials.gov.

  1. DIFOCCULT-3: Time for a diagnostic paradigm shift from STEMI/NSTEMI to OMI/NOMI

    Prospective study comparing an OMI/NOMI approach with the STEMI/NSTEMI paradigm for predicting acute coronary occlusion, infarct size, LV function and long-term outcomes. Design paper published in JACC: Advances 2025.

    TrialNCT06570759

  2. TITAN-OMI: Ticino Artificial InTelligence integrAtioN for Occlusion Myocardial Infarction

    Randomized trial (Cardiocentro Ticino) of AI-assisted ECG interpretation with PMcardio in suspected ACS patients who do not meet STEMI criteria.

    TrialNCT07077057

  3. ANOMI: Artificial intelligence based timing, infarct size and outcomes in acute coronary occlusion MI without ST elevation

    Prospective observational study (Bolzano) of AI-powered ECG interpretation, timing of angiography and infarct size in suspected ACS without clear ST elevation.

    TrialNCT06910436

  4. AID-OMIE: Artificial Intelligence in Detection of Occlusive Myocardial Infarction in Emergency Medicine

    Observational study of AI-assisted 12-lead ECG interpretation to detect OMI in patients resuscitated after out-of-hospital cardiac arrest.

    TrialNCT06767709

Titles without a direct link open a PubMed search for that paper.

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