Occlusion-Focused Triage vs Very-High-Risk NSTEMI Criteria: A DIFOCCULT-3 Substudy.
Emre K Aslanger, Burcu Aggül, Özlem Yıldırımtürk et al.
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In 30 seconds
This substudy of the multicenter, cluster-randomized DIFOCCULT-3 trial compared occlusion/nonocclusion (OMI/NOMI) classification with the conventional STEMI/NSTEMI framework and guideline-defined very-high-risk NSTEMI criteria in adults without diagnostic ST elevation on admission ECG. Among 4,398 patients, the OMI/NOMI approach selected more patients for invasive management within 2 hours (45.4% vs 13.6%; P < 0.001) and was associated with more frequent identification of adjudicated acute coronary occlusion within 2 hours (35.1% vs 16.7%; P < 0.001), without reducing angiographic yield.
Key findings
- Immediate invasive management was more frequent with OMI/NOMI than with the conventional STEMI/NSTEMI framework (45.4% vs 13.6%; P < 0.001).
- Adjudicated acute coronary occlusion was identified within 2 hours more often with OMI/NOMI (35.1% vs 16.7%; P < 0.001).
- Very-high-risk NSTEMI criteria identified few patients and were inconsistently translated into early intervention.
Why it matters
In patients presenting without diagnostic ST elevation, conventional STEMI/NSTEMI categorisation and very-high-risk NSTEMI criteria may not consistently identify acute coronary occlusion or prompt early intervention. These findings suggest that an occlusion-focused classification may help identify more patients with occlusion sooner, while maintaining angiographic yield. The results inform evaluation of diagnostic and triage frameworks but do not establish improved clinical outcomes.