ArticleJACC. Advances2025
A Diagnostic Paradigm Shift in Acute Myocardial Infarction: Rationale and Design of the DIFOCCULT-3 Trial.
Article in JACC. Advances, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06570759 (Time for a DIagnostic Paradigm Shift From ST-elevation/Non-ST-elevation to OCClUsion/Non-occLusion Myocardial infarcTion), which is not on this map. Cited by 7 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Time for a DIagnostic Paradigm Shift From ST-elevation/Non-ST-elevation to OCClUsion/Non-occLusion Myocardial infarcTion
Who cites it
7 citing papers in PubMed.
- Electrocardiogram sonification accelerates detection of ST elevation myocardial infarction compared to analysis based solely on visual display: a randomized controlled simulation study with medical students.BMC emergency medicine · 2026Trial
- Specificity of the Occlusion Myocardial Infarction-Trained PMcardio "Queen of Hearts" AI-ECG in Inflammatory Myopericardial Syndromes.JACC. Advances · 2026Article
- A Wearable Infrared Sensor for Detecting Non-ST Segment Elevation Acute Coronary Syndromes.Life (Basel, Switzerland) · 2026Article
- From Electrocardiography to the Catheterization Laboratory: A Multimodal Artificial Intelligence Framework for Acute Coronary Syndrome Detection and Risk Stratification.Diagnostics (Basel, Switzerland) · 2026Review
- Detecting Occlusion Myocardial Infarction with an AI-Powered ECG Model: A Retrospective Cohort Study.Journal of personalized medicine · 2026Article
- Behavioral Intelligence in Action: Implementation Science and Cardiovascular Learning Health Systems.JACC. Advances · 2025Article
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Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe current ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) paradigm have long been the cornerstone of myocardial infarction (MI) care but fail to identify many patients with acute coronary occlusion (ACO), delaying treatment and worsening outcomes.
objectivesThe new occlusive MI (OMI) and nonocclusive MI (NOMI) paradigm addresses these limitations by shifting from rigid electrocardiography (ECG)-driven thresholds to a pathophysiology-based strategy. It integrates clinical judgment, ECG subtleties, supportive artificial intelligence, biomarkers, and imaging when needed to actively detect ACO. The current trial investigates whether this approach improves outcomes.
methodsThe DIFOCCULT-3 (Time for a DIagnostic paradigm shift from ST-elevation/non-ST-elevation to OCClUsion/non-occLusion myocardial infarcTion? trial is a multicenter, modified cluster-randomized, open-label study designed to compare the OMI/NOMI paradigm with the STEMI/NSTEMI approach in 6,000 participants presenting with suspected MI. The OMI/NOMI approach integrates clinical gestalt, artificial intelligence-supported ECG analysis, and adjunctive diagnostic tools to actively identify ACO. The primary endpoint is the composite of all-cause mortality and all-cause rehospitalization at 1-year follow-up. Secondary endpoints include infarct size, left ventricular ejection fraction, wall motion score index, and accurate diagnosis of ACO.
resultsEnrollment and follow-up are ongoing; acute outcomes such as earlier identification of ACO and infarct size will be reported after enrollment, and late outcomes including mortality and rehospitalization will be available after 1-year follow-up.
conclusionsThe DIFOCCULT-3 study aims to determine whether the OMI/NOMI paradigm represents a significant advancement in MI care by improving outcomes through earlier and more accurate identification of ACO than the STEMI/NSTEMI framework (Time for a Diagnostic Paradigm Shift From STEMI/NSTEMI to OMI/NOMI [DIFOCCULT-3]; NCT06570759).
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