Frequency and Prognosis of Alternative Definitions of Occlusion Myocardial Infarction Across the Whole Spectrum of Acute Coronary Syndromes.

Authors

Andrea Milzi, Andrea Zito, Antonio Landi, Enrico Frigoli, Giuseppe Andò, Giacomo Boccuzzi, Paolo Calabrò, Gianluca Campo, Marco Frazzetto, Marco Covani, Jose Maria De La Torre Hernandez, Dik Heg, Sergio Leonardi, Filippo Russo, Gennaro Sardella, Arnoud Wj Vant'Hof, Ferdinando Varbella, Pascal Vranckx, Marco Valgimigli

Published in

JACC. Cardiovascular interventions. Volume 19. Issue 19. Pages 2571-2585. Oct 12, 2026.

Abstract

Occlusion myocardial infarction (OMI) refers to a myocardial infarction caused by a persistent or transient, complete or near-complete coronary artery occlusion. Multiple definitions have been proposed, yet their frequency and comparative prognostic relevance remain unclear.
This study sought to evaluate the frequency and prognosis of previously proposed OMI definitions across the whole spectrum of acute coronary syndromes (ACS) from the MATRIX trial.
Five alternative OMI definitions were assessed: 1) culprit artery (CA) TIMI flow grade 0; 2) CA-TIMI flow grade 0-1; 3) CA-TIMI flow grade 0-2; 4) CA-TIMI flow grade 0-2 or TIMI flow grade 3 with cardiac troponin >30× upper reference limit; and 5) CA-TIMI flow grade 0-2 or CA-TIMI flow grade 3 with cardiac troponin >100× upper reference limit. The endpoint of interest was 1-year all-cause mortality.
Among 6,558 patients with ACS, OMI frequency ranged from 37.8% for definition 1 to 76.1% for definition 4. OMI was independently associated with higher 1-year mortality according to definitions 1-4 (adjusted HR: 2.08 [95% CI: 1.56-2.78], 1.97[1.47-2.63], 1.70 [1.25-2.32], 1.47 [1.01-2.12], respectively) but not according to definition 5 (adjusted HR: 1.26 [0.90-1.75]). OMI definitions exclusively based on impaired CA flow (ie, definitions 1-3) improved discrimination, reclassification, and model fit when added to the conventional STE/NSTE-ACS classification. One-year mortality did not differ among patients with NSTE-ACS with OMI definition 1 or 2 compared with ST-segment elevation MI (STEMI) patients.
OMI defined by impaired CA flow confers prognostic implications beyond the presence or absence of ST-segment elevation in a broad ACS population and identifies patients without ST-segment elevation with 1-year mortality similar to that of STEMI.

PMID:
42863869
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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