Non-ST Elevation Myocardial Infarction
- 1Department of Cardiovascular Medicine, UCSF-Fresno, Fresno, CA 93701-2302, USA
Abstract
Non-ST-elevation myocardial infarction (NSTEMI) is the most common acute coronary syndrome presentation and represents a heterogeneous clinical entity with distinct mechanisms and distinct diagnostic and therapeutic implications. This narrative review summarizes contemporary concepts in NSTEMI pathophysiology, classification, angiographic phenotypes, and treatment strategies, with an emphasis on differentiating Type 1 from Type 2 myocardial infarction (MI) and the implications for revascularization decisions. The PubMed/MEDLINE database was searched for English-language publications addressing NSTEMI pathophysiology, classification, diagnosis, and management, supplemented by the most recent American and European acute coronary syndrome guidelines, the Universal Definition of Myocardial Infarction, landmark randomized controlled trials, and pivotal mechanistic and intravascular imaging studies, with priority given to contemporary and high-impact sources. NSTEMI emerges as a heterogeneous syndrome rather than a single disease, and optimal care depends on identifying the underlying mechanism. This requires distinguishing myocardial infarction from myocardial injury, separating Type 1 atherothrombosis from Type 2 supply–demand mismatch, and recognizing entities such as myocardial infarction with non-obstructive coronary arteries and spontaneous coronary artery dissection. A mechanism-specific approach should guide antithrombotic therapy and revascularization decisions, and the transition from a syndromic label to an individualized, mechanism-based diagnosis is essential for optimizing patient outcomes.
Related
- ST-Segment Elevation Myocardial Infarction Secondary to Aortic Root Thrombosis in a Patient With a Left Ventricular Assist Device
- Anomalous left coronary artery origin unmasked by non-ST-elevation myocardial infarction
- Outcome Stratification in Non-ST-Segment Elevation Myocardial Infarction: Standardized Assessment of Left Ventricular Global Longitudinal Strain
- Simultaneous two-vessel occlusion causing ST-segment elevation myocardial infarction associated with elevated lipoprotein (a): A case report
- Association Between Admission Calculated Serum Osmolality and New-Onset Atrial Fibrillation in Patients with Non-ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention
BibTeX
@article{asadourian2026nonst,
title = {{Non-ST Elevation Myocardial Infarction}},
author = {Miro Asadourian and John A. Ambrose},
journal = {Reviews in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.31083/rcm52864},
url = {https://doi.org/10.31083/rcm52864},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Non-ST Elevation Myocardial Infarction
AU - Miro Asadourian
AU - John A. Ambrose
PY - 2026
DA - 2026/10/13
JO - Reviews in Cardiovascular Medicine
DO - 10.31083/rcm52864
UR - https://doi.org/10.31083/rcm52864
AB - Non-ST-elevation myocardial infarction (NSTEMI) is the most common acute coronary syndrome presentation and represents a heterogeneous clinical entity with distinct mechanisms and distinct diagnostic and therapeutic implications. This narrative review summarizes contemporary concepts in NSTEMI pathophysiology, classification, angiographic phenotypes, and treatment strategies, with an emphasis on differentiating Type 1 from Type 2 myocardial infarction (MI) and the implications for revascularization decisions. The PubMed/MEDLINE database was searched for English-language publications addressing NSTEMI pathophysiology, classification, diagnosis, and management, supplemented by the most recent American and European acute coronary syndrome guidelines, the Universal Definition of Myocardial Infarction, landmark randomized controlled trials, and pivotal mechanistic and intravascular imaging studies, with priority given to contemporary and high-impact sources. NSTEMI emerges as a heterogeneous syndrome rather than a single disease, and optimal care depends on identifying the underlying mechanism. This requires distinguishing myocardial infarction from myocardial injury, separating Type 1 atherothrombosis from Type 2 supply–demand mismatch, and recognizing entities such as myocardial infarction with non-obstructive coronary arteries and spontaneous coronary artery dissection. A mechanism-specific approach should guide antithrombotic therapy and revascularization decisions, and the transition from a syndromic label to an individualized, mechanism-based diagnosis is essential for optimizing patient outcomes.
SN - 1530-6550
SN - 2153-8174
ER -