A 55-year-old man presents with 2 hours of chest pain. ECG shows ST depression of 2mm in leads V4-V6 with T-wave inversion, but no ST elevation. Troponin I is elevated at 0.8 ng/mL. Coronary angiography reveals a tight stenosis of the proximal left anterior descending artery. Which term best describes this presentation?
- A ST-elevation myocardial infarction (STEMI)
- B Non-ST-elevation myocardial infarction (NSTEMI) ✓
- C Unstable angina
- D Myocardial injury
Correct answer: B. Non-ST-elevation myocardial infarction (NSTEMI)
Explanation
NSTEMI is diagnosed when there is clinical evidence of acute myocardial necrosis (elevated troponin above the 99th percentile) with ischemic symptoms, without persistent ST elevation on ECG. ST depression and T-wave inversion are typical ECG findings. Unstable angina would have similar presentation but with normal troponin. STEMI requires ST elevation (or equivalent patterns like new LBBB or posterior MI). Myocardial injury is a broader term not specific to acute coronary syndrome.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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