A Non–ST-Segment Elevation Myocardial Infarction: An Emergent Condition- Main Role of Emergency Providers and Clinical Pathologists: A Review

Alqahtan, Amjad Ali; Alshareef, Sharaf Abdullah A; Al-Hadlaq, Zaid Abdulrahman; Almalki, Ayidh Yahya Jaber; ALHAYYAN, KHALID SULAIMAN M; ALOUFI, SAIF MASAD SAUD; Bin Barghash, Abdullah Murdhi; ALMUDHISH, FAHAD RASHED; ALARAG, MOHAMMED YAHYA; ALAMRI, ABDULRAHMAN MARI; ALANAZI, SAAD MUSHAWWAH; Alshahrani, Safar Ali

doi:10.21608/jmals.2024.425349

A Non–ST-Segment Elevation Myocardial Infarction: An Emergent Condition- Main Role of Emergency Providers and Clinical Pathologists: A Review

Document Type : Original Article

Authors

¹ Prince Sultan Cardiac Center, Saudi Arabia

² PRINCE SULTAN MILITARY MEDICAL CITY, Saudi Arabia

³ Ministry of Defense Health Services, Hafr Al Batin, Saudi Arabia

⁴ Ministry of Defense, Prince Sultan Air Base, Saudi Arabia

⁵ King Fahad Medical City, Riyadh Second Health Cluster, Saudi Arabia

10.21608/jmals.2024.425349

Abstract

Background: Non-ST-segment elevation myocardial infarction (NSTEMI) is a critical subtype of acute coronary syndrome (ACS) characterized by partial coronary occlusion and elevated cardiac biomarkers. Despite lacking ST elevation on ECG, NSTEMI carries significant morbidity and mortality risks, necessitating prompt diagnosis and management. Emergency providers and clinical pathologists play pivotal roles in early recognition, diagnosis, and intervention.
Aim: This review examines the pathophysiology, diagnostic challenges, and evidence-based management strategies for NSTEMI, emphasizing the collaborative roles of emergency and laboratory medicine teams.
Methods: A synthesis of current guidelines and clinical studies was conducted, focusing on risk stratification (e.g., GRACE, TIMI scores), biomarker interpretation (high-sensitivity troponin), and therapeutic protocols (anticoagulation, revascularization timing).
Results: NSTEMI accounts for 70% of ACS cases, with outcomes heavily influenced by timely troponin testing and ECG interpretation. Key findings include that High-sensitivity troponin assays enable earlier diagnosis (within 2–4 hours) but require serial measurements. Early invasive strategies (<24 hours) reduce mortality in high-risk patients (GRACE score >140). Complications like heart failure (15–20% incidence) and renal dysfunction (25–30%) underscore the need for multidisciplinary care.
Conclusion: Effective NSTEMI management hinges on coordinated efforts between emergency providers (rapid triage), pathologists (biomarker accuracy), and cardiologists (definitive care). Future directions include refined risk assessment tools and personalized therapies.

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