Clinical meaning
STEMI represents complete coronary artery occlusion with transmural ischemia (full wall thickness), producing ST elevation on ECG. NSTEMI involves partial occlusion or complete occlusion with collateral flow, causing subendocardial ischemia with ST depression or T-wave inversion and elevated troponin.
Diagnosis & workup
Diagnostics & workup: - Order 12-lead ECG within 10 minutes (repeat every 15-30 min if initial non-diagnostic) - Order high-sensitivity troponin at 0 and 1-3 hours - Order echocardiogram for wall motion abnormalities - Order TIMI or GRACE risk score for NSTEMI - Order coronary angiography based on risk stratification - Order chest X-ray to evaluate for alternative diagnoses
Risk factors: - Prior coronary artery disease - Multiple cardiovascular risk factors - Diabetes (may mask chest pain symptoms) - Chronic kidney disease - Prior coronary stent (in-stent thrombosis) - Cocaine/methamphetamine use - Premature family history of CAD