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ACOMI — RACP Adult Medicine MCQ

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HardCardiologyACOMIRACP Adult Medicine

A 58-year-old man presents with acute chest tightness. His ECG shows new LBBB with a positive Sgarbossa criteria (concordant ST elevation >1 mm in leads with positive QRS). According to the 2025 Australian ACS guideline, this ECG pattern is now recognised as which entity?

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Correct answer: C — STEMI-equivalent

The 2025 Australian ACS guideline introduces the concept of acute coronary occlusion MI (ACOMI), which broadens recognition of ECG patterns requiring emergent reperfusion beyond traditional STEMI criteria. New LBBB with concordant ST changes (Sgarbossa criteria) is classified as an ACOMI pattern requiring the same urgent management as traditional STEMI – emergent PCI or fibrinolysis.

Reference: NHF/CSANZ – 2025 – Australian Clinical Guideline for Diagnosing and Managing ACS