不夠毫米的閉塞，最容易被晚一步

Nossen M；Grauer K評論，〈50 something male with acute chest pain〉，Dr. Smith's ECG Blog（Smith心電圖部落格），2026-10-15。原文：「This ECG is from a man in his early 50s with a history of bilateral pulmonary embolism who presented with acute shortness of breath and chest pain.」；「This ECG shows sinus rhythm 74 beats per minute.」；「This pattern is absolutely diagnostic of LAD OMI」；「The numerical output was 1.00」；「From hospital arrival (and the recording of ECG #1) until cath lab activation — 60 minutes passed.」；「LAD 90% stenosis; LCx 50% stenosis; OM1 99% stenosis」；「TIMI 3 was noted in all coronaries」；「ECG #2 shows a regular wide complex rhythm with a rate of 103 beats per minute.」；「No specific treatment was given for the bifocal AIVR in today’s case, which spontaneously resolved after a limited period of time.」；「Initial conventional Troponin I returned at 27ng/L」；「ECG #2 is consistent with AIVR (Accelerated IdioVentricular Rhythm) with 2 foci of automaticity.」；「The Queen of Hearts AI model did not recognize this example of AIVR as a reperfusion ECG.」；「Troponin I rose to 3960ng/L but was not measured to peak.」。跳到原文 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Grauer K，My Comment（10/15/2026），收錄於〈50 something male with acute chest pain〉，Dr. Smith's ECG Blog（Smith心電圖部落格），2026-10-15。原文：「giant T wave (that attains 10 mm in height in leads V3,V4)」；「J-point ST elevation. This strongly suggests a very proximal LAD lesion.」；「Reciprocal ST depression in each of the inferior leads」；「bifocal AIVR tends to be a slower ventricular rhythm form that manifests a more regular R-R interval with less extreme axis shift」；「It may not always be easy to distinguish between bidirectional VT vs bifocal AIVR」；「bidirectional VT that arises as a result of acute ischemia is a much more dangerous rhythm at risk of deteriorating to VFib.」。跳到原文 ↩︎

Smith SW、de Alencar JN，〈The Unlucky Occlusion Patients Missed by the STEMI/NSTEMI Paradigm May Be Found by OMI/NOMI〉，JACC: Cardiovascular Interventions（JACC心血管介入），2026;19(19):2552-2554（PMID 42863866），利益衝突聲明。原文：「Dr Smith holds stock in Powerful Medical, maker of the PMCardio Queen of Hearts AI ECG Model.」。跳到原文 ↩︎ ↩︎ ↩︎ ↩︎

Nossen M；Smith SW、Grauer K評論，〈Is this OMI, Subendocardial ischemia, LVH, or some combination?〉，Dr. Smith's ECG Blog（Smith心電圖部落格），2026-10-11。原文：「An ECG was obtained from an elderly male nursing home resident who was referred to the emergency department because of shortness of breath and confusion.」；「The Queen of Hearts AI model classified ECG #1 as “Inconclusive.”」；「The subsequent hs‑cTnI rose dramatically to 56,420 ng/L」；「SEI generally has hs-cTnI well below 5000 ng/L」；「Refractory ischemia needs emergent cath lab activation regardless of OMI or SEI.」；「I can identify at least 5 distinct P‑wave morphologies in this ECG.」。跳到原文 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Grauer K，My Comment（10/11/2026），收錄於〈Is this OMI, Subendocardial ischemia, LVH, or some combination?〉，Dr. Smith's ECG Blog（Smith心電圖部落格），2026-10-11。原文：「Rather than antiarrhythmic medication — optimizing pulmonary function is the best treatment approach.」。跳到原文 ↩︎

Aslanger EK、Aggül B、Yıldırımtürk Ö、Karabay CY、Meyers HP、Smith SW等，〈Occlusion-Focused Triage vs Very-High-Risk NSTEMI Criteria: A DIFOCCULT-3 Substudy〉，JACC: Cardiovascular Interventions（JACC心血管介入），2026;19(19):2555-2566（PMID 42863867）。原文：「This was a substudy of the multicenter, cluster-randomized DIFOCCULT-3」；「The OMI/NOMI approach selected more patients for early invasive management compared with the STEMI/NSTEMI framework (45.4% vs 13.6%; P < 0.001).」；「Adjudicated ACO was identified within 2 hours more frequently under the OMI/NOMI approach (35.1% vs 16.7%; P < 0.001), without reduction in angiographic yield.」；利益衝突聲明：「Drs Meyers and Smith hold stock in Powerful Medical.」。跳到原文 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Kherallah RY、Zaid S、Assaf Y等，〈Acute Coronary Occlusions in NSTEMI Undergoing Percutaneous Coronary Intervention: Insights From the CathPCI Registry〉，JACC: Cardiovascular Interventions（JACC心血管介入），2026;19(19):2539-2551（PMID 42863865）。原文：「ACO was defined as 100% stenosis deemed acute.」；「Of 1,198,544 patients, 26.1% had STEMI, 11.0% had NSTEMI-ACO」；「adjusted OR: 2.26; 95% CI: 2.18-2.34」；「NSTEMI-ACO accounted for 216,054 presentations (24.4% of NSTEMI)」；利益衝突聲明：「The analysis was funded by the American College of Cardiology’s National Cardiovascular Data Registry.」、「The authors have reported that they have no relationships relevant to the contents of this paper to disclose.」。跳到原文 ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Hassan S、Holm H、de Lange F、Kenny RA、Brignole M、Fedorowski A，〈Coexistance of Carotid Sinus Hypersensitivity and Orthostatic Hypotension in Patients with Unexplained Syncope〉，Europace（歐洲節律），2026-10-16（PMID 42885833）。原文：「A total of 1,908 patients aged ≥40 years」；「CSH was present in 320 patients (16.8%, 72.2 ± 9.9 years), and was more common in patients with OH than without OH (24.1% vs. 13.3%, p < 0.001). Among patients with CSH, 46.6% also had OH.」；「An asystolic CSM response was observed more often in OH patients (n = 42; 6.8%) compared with non-OH patients (n = 44, 3.4%, p < 0.001)」。跳到原文 ↩︎ ↩︎ ↩︎ ↩︎

van der Pol L、Tomasik B、Hoeksema W、Mandija S等，〈Stereotactic arrhythmia radioablation for refractory ventricular tachycardia: the STOPSTORM.eu study〉，European Heart Journal（歐洲心臟期刊），2026-10-14。原文（標題）：「Stereotactic arrhythmia radioablation for refractory ventricular tachycardia: the STOPSTORM.eu study」。跳到原文 ↩︎

Padalia K、Fornaro A、Claggett B等，〈Genotype and arrhythmic risk in dilated cardiomyopathy〉，European Heart Journal（歐洲心臟期刊），2026-10-13。原文（標題）：「Genotype and arrhythmic risk in dilated cardiomyopathy」。跳到原文 ↩︎

Knapp J、Greif R、Bathe J、Wnent J等，〈Amiodarone after conversion from a non-shockable to a shockable rhythm in out-of-hospital cardiac arrest〉，Resuscitation（急救期刊），2026-12。原文（標題）：「Amiodarone after conversion from a non-shockable to a shockable rhythm in out-of-hospital cardiac arrest」。跳到原文 ↩︎