Up to 24 hours
- Failed thrombolysis and persistent infarct related chest pain
- Prolonged Infarct pain in spite of successful thrombolysis (Rare)
- Dual STEMI and Dual ACS ( Combination of STEMI/NSTEMI) *
* Generally until after 24 hours one should not make a second coronary syndrome though logically it is possible ( Dual acute coronary syndrome)
After 24 hours -up to 2 weeks
- Post MI angina – IRA related (Re-occlusion, Threatened reocclusion)
- Post MI angina -Non IRA related ( Critical non -IRA lesion)
- Thrombus migration /Side branch occlusion
- Re infarction -Same territory
- Re-infarction-Remote territory
- Infarct extension, Infarct expansion , Dyskinetic segments ( Acute ventricular remodeling has a potential to generate pain )
- Combinations of the above
24 hour is arbitrary cut off .There can be spill overs and over laps
*Refractory non ischemic chest pain often atypical not relieved by anti anginal medication – Pericardits, Coronary dissections , myocardial /Pap muscle tears .
Do we need to break our brain to find the source of angina following STEMI ?
Principles of scientific medicine would demand it . However in this era of hyper active interventional cardiologists there is little purpose as they tend to open up all occluded arteries guided by the their ignorance about the source of chest pain.