Unreliability of the STEMI vs NSTEMI distinction

This is just a case report but it illustrates the growing awareness of this problem. The authors conclude:

ST-segment elevation only may not always reflect ongoing ischaemia and we should no longer focus on the presence or absence of ST-segment elevation as a reliable criteria to proceed or to postpone urgent angiography and/or reperfusion therapy [1, 2]. Future studies should focus on the NSTEMI ACS algorithm and its identification of high-risk patients who may benefit from urgent coronary angiography and subsequent revascularisation [3, 4, 5]. In our opinion, the acute myocardial infarction classification based on ST elevation alone should be reconsidered.