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Makale Tam Makale Uluslararası 2025

A Diagnostic Paradigm Shift in Acute Myocardial Infarction: Rationale and Design of the DIFOCCULT-3 Trial

Emre K. Aslanger, Özlem Yıldırımtürk, Can Yücel Karabay, H. Pendell Meyers, Stephen W. Smith, Muzaffer Değertekin, H.Pendell Meyers, Stephen W. Smith, Belma Kalaycı, Ahmet Burak Erdem, Havva Tuğba Gürsoy, Ahmet Akdi, Sinan Cemgil Özbek, Veysel Ozan Tanık, Arzu Neslihan Akgün, Ertan Ekici, Gürbey Söğüt, Tolgahan Efe, Ayşenur Özkaya İbiş, Çağatay Tunca, Yunus Öz, İbrahim Halil Uygun, Buse Çuvalcıoğlu, Muhammed Aydın, Ezgi Polat Ocaklı, Tuğba Kayhan Altuner, Dursun Akaslan, Murat Esin, Burcu Özyazgan, İrem Kılınçkaya Aydın, Ali Oğuzhan Karal, Esra Dönmez, Sevgi Özcan, Orhan İnce, Muhammed Furkan Deniz, İrfan Şahin, Abuzer Coşkun, Mustafa Rauf Karayumak, Ersin İbişoğlu, Uğur Ozan Demirhan, Aslan Erdoğan, Eyüp Özkan, İlyas Çetin, Yusuf İnci, Semih Kalkan, Ufuk Yıldız, Said Kural, Tuba Danacı, Burcu Kırbıyık, Merve Aslı Işık, Utku Uluköksal, Furkan Fatih Yücedağ, Elif Özoğuz, Oktay Şeker, Barış Yaylak, Ufuk Sadık Ceylan, Gönül Zeren, Mustafa Azmi Sungur, Mehmet Fatih Yılmaz, Tolga Onuk, Oğuzhan Birdal, Sidar Şiyar AYDIN, Erdal Tekin, Emrah İlkay Varınca, Ezgi Çamlı Babayiğit, Halit Emre Yalvaç, Emre Şener, Hazal Tıraş, Barış Özden, Ayberk Beral, Kadir Uğur Mert, Gurbet Özge Mert, Cihat Çalışkan, Azmican Kaya, Metehan Kibar, Mustafa Furkan Kılıçarslan, Emre Kipritçi, Şeyma Zeynep Atıcı, Simay Erdal, Sedat Kalkan, Çetin Geçmen, Muzaffer Kahyaoğlu, Mehmet Aytürk, Mevlut Demir, Taner Şen, Halil İbrahim Durmuş, Emrah Kaya, Fatih Kahraman, Celal Kilit, Mehmet Ali Astarcıoğlu, Veysel Elitas, Yakup Han Yılmaz, Uğur Güven, Zekeriya Dogan, Eren Uysaler, Ahmet Cem Nizam, Tansu Çelik, Ebrunur Türkmen, Berke Çavuş, Fevzi Sünbül, Sena Nasif, Melih Gözünke, Ahmet Anıl Şahin, Ayhan Kol, Doğancan Çeneli, Sinan Karacabey, Serhat Bulut, Ayşe Zeynep İnan, Mustafa Aytemiz, Emre Kudu, Mehmet Birkan Korgan, Mustafa Altun, Mehmet Oğuzhan Narlı, Elif Yaren Yurtman, Mehmet Ertürk, Ümit Bulut, Dama Hatice Kübra, Utku Yartaşı, Shabnam Huseynova, Gizemnur Coşkun, Mustafa Can Gündoğdu, Dilara Pay, Özcan Başaran, Bülent Özlek, İbrahim Altun, Süleyman Barutçu, Zahit Arda Tok, Tolga Terdöken, Serhat Kesriklioglu, Muhammed Fatih Kaleli, Mehmet Akif Düzenli, Sümeyye Toprak, Ferit Recepoğlu, Leyla Feyzullayeva, Mertcan Gezer, Emirhan Feyzullahoglu, Nuraiym Moloshova, Şener Gür, Ahmet Şalvarcı, Mücahit Kılavuz, Mustafa Çelik, Yakup Alsancak, Ahmet Seyfeddin Gurbuz, Sefa Tatar, Barış Güven, Mehmet Emin Gökçe, Çağrı Zorlu, Sefa Erdi Ömür, Ahmet Şimşek, Yağmur Demirezen, Ömer Kümet, Görkem Ayhan, Medeni Karaduman, Ertuğ Günsoy, Veysi Can, Remzi Sarıkaya, Yemlihan Ceylan, Yüksel Kaya, Mehmet Şirin Türkan, Emre K. Aslanger, Burcu Aggül, Burcu Aggül, Özlem Yıldırımtürk, Can Yücel Karabay, Muzaffer Değertekin, Gamze Acar, Şeyma Acaroğlu, Hüseyin Akgün, Orkun Canbolat, Fatma Ekici, Muhammed Mert Göksu, Ufuk Sali Halil, Emel Hamkan, Furkan Karaca, Şevval Kılıç, Cansu Göksenin Özdoğan, Furkan Saarıkafa, Melek Topçu, Ömer Türkmen, Emrah Bozbeyoğlu, Funda Özlem Pamuk, Mustafa Emin Çanakçı, Ramazan Güven

JACC: Advances Cilt 4 · Sayı 11 · 01.11.2025
DOI ile aç

Özet

Background: The 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. Objectives: The 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. Methods: The 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. Results: Enrollment 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. Conclusions: The 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)

Anahtar kelimeler

MYOCARDIAL-INFARCTION randomized controlled trial PERCUTANEOUS CORONARY INTERVENTION acute coronary syndromes ST-segment elevation

Atıf için künye

Aslanger, E. K., Yıldırımtürk, Ö., Karabay, C. Y., Meyers, H. P., Smith, S. W., Değertekin, M., Meyers, H., Smith, S. W., Kalaycı, B., Erdem, A. B., Gürsoy, H. T., Akdi, A., Özbek, S. C., Tanık, V. O., Akgün, A. N., Ekici, E., Söğüt, G., Efe, T., İbiş, A. Ö., … Güven, R. (2025). A Diagnostic Paradigm Shift in Acute Myocardial Infarction: Rationale and Design of the DIFOCCULT-3 Trial. JACC: Advances, 4(11). https://doi.org/10.1016/j.jacadv.2025.102227

BibTeX
@article{aslanger2025-220510,
  author = {Aslanger, Emre K. and Yıldırımtürk, Özlem and Karabay, Can Yücel and Meyers, H. Pendell and Smith, Stephen W. and Değertekin, Muzaffer and Meyers, H.Pendell and Smith, Stephen W. and Kalaycı, Belma and Erdem, Ahmet Burak and Gürsoy, Havva Tuğba and Akdi, Ahmet and Özbek, Sinan Cemgil and Tanık, Veysel Ozan and Akgün, Arzu Neslihan and Ekici, Ertan and Söğüt, Gürbey and Efe, Tolgahan and İbiş, Ayşenur Özkaya and Tunca, Çağatay and Öz, Yunus and Uygun, İbrahim Halil and Çuvalcıoğlu, Buse and Aydın, Muhammed and Ocaklı, Ezgi Polat and Altuner, Tuğba Kayhan and Akaslan, Dursun and Esin, Murat and Özyazgan, Burcu and Aydın, İrem Kılınçkaya and Karal, Ali Oğuzhan and Dönmez, Esra and Özcan, Sevgi and İnce, Orhan and Deniz, Muhammed Furkan and Şahin, İrfan and Coşkun, Abuzer and Karayumak, Mustafa Rauf and İbişoğlu, Ersin and Demirhan, Uğur Ozan and Erdoğan, Aslan and Özkan, Eyüp and Çetin, İlyas and İnci, Yusuf and Kalkan, Semih and Yıldız, Ufuk and Kural, Said and Danacı, Tuba and Kırbıyık, Burcu and Işık, Merve Aslı and Uluköksal, Utku and Yücedağ, Furkan Fatih and Özoğuz, Elif and Şeker, Oktay and Yaylak, Barış and Ceylan, Ufuk Sadık and Zeren, Gönül and Sungur, Mustafa Azmi and Yılmaz, Mehmet Fatih and Onuk, Tolga and Birdal, Oğuzhan and AYDIN, Sidar Şiyar and Tekin, Erdal and Varınca, Emrah İlkay and Babayiğit, Ezgi Çamlı and Yalvaç, Halit Emre and Şener, Emre and Tıraş, Hazal and Özden, Barış and Beral, Ayberk and Mert, Kadir Uğur and Mert, Gurbet Özge and Çalışkan, Cihat and Kaya, Azmican and Kibar, Metehan and Kılıçarslan, Mustafa Furkan and Kipritçi, Emre and Atıcı, Şeyma Zeynep and Erdal, Simay and Kalkan, Sedat and Geçmen, Çetin and Kahyaoğlu, Muzaffer and Aytürk, Mehmet and Demir, Mevlut and Şen, Taner and Durmuş, Halil İbrahim and Kaya, Emrah and Kahraman, Fatih and Kilit, Celal and Astarcıoğlu, Mehmet Ali and Elitas, Veysel and Yılmaz, Yakup Han and Güven, Uğur and Dogan, Zekeriya and Uysaler, Eren and Nizam, Ahmet Cem and Çelik, Tansu and Türkmen, Ebrunur and Çavuş, Berke and Sünbül, Fevzi and Nasif, Sena and Gözünke, Melih and Şahin, Ahmet Anıl and Kol, Ayhan and Çeneli, Doğancan and Karacabey, Sinan and Bulut, Serhat and İnan, Ayşe Zeynep and Aytemiz, Mustafa and Kudu, Emre and Korgan, Mehmet Birkan and Altun, Mustafa and Narlı, Mehmet Oğuzhan and Yurtman, Elif Yaren and Ertürk, Mehmet and Bulut, Ümit and Kübra, Dama Hatice and Yartaşı, Utku and Huseynova, Shabnam and Coşkun, Gizemnur and Gündoğdu, Mustafa Can and Pay, Dilara and Başaran, Özcan and Özlek, Bülent and Altun, İbrahim and Barutçu, Süleyman and Tok, Zahit Arda and Terdöken, Tolga and Kesriklioglu, Serhat and Kaleli, Muhammed Fatih and Düzenli, Mehmet Akif and Toprak, Sümeyye and Recepoğlu, Ferit and Feyzullayeva, Leyla and Gezer, Mertcan and Feyzullahoglu, Emirhan and Moloshova, Nuraiym and Gür, Şener and Şalvarcı, Ahmet and Kılavuz, Mücahit and Çelik, Mustafa and Alsancak, Yakup and Gurbuz, Ahmet Seyfeddin and Tatar, Sefa and Güven, Barış and Gökçe, Mehmet Emin and Zorlu, Çağrı and Ömür, Sefa Erdi and Şimşek, Ahmet and Demirezen, Yağmur and Kümet, Ömer and Ayhan, Görkem and Karaduman, Medeni and Günsoy, Ertuğ and Can, Veysi and Sarıkaya, Remzi and Ceylan, Yemlihan and Kaya, Yüksel and Türkan, Mehmet Şirin and Aslanger, Emre K. and Aggül, Burcu and Aggül, Burcu and Yıldırımtürk, Özlem and Karabay, Can Yücel and Değertekin, Muzaffer and Acar, Gamze and Acaroğlu, Şeyma and Akgün, Hüseyin and Canbolat, Orkun and Ekici, Fatma and Göksu, Muhammed Mert and Halil, Ufuk Sali and Hamkan, Emel and Karaca, Furkan and Kılıç, Şevval and Özdoğan, Cansu Göksenin and Saarıkafa, Furkan and Topçu, Melek and Türkmen, Ömer and Bozbeyoğlu, Emrah and Pamuk, Funda Özlem and Çanakçı, Mustafa Emin and Güven, Ramazan},
  title = {A Diagnostic Paradigm Shift in Acute Myocardial Infarction: Rationale and Design of the DIFOCCULT-3 Trial},
  journal = {JACC: Advances},
  year = {2025},
  volume = {4},
  number = {11},
  issn = {2772-963X},
  doi = {10.1016/j.jacadv.2025.102227},
  url = {https://akademik.atauni.edu.tr/yayinlar/220510-a-diagnostic-paradigm-shift-in-acute-myocardial-infarction-rationale-and-design}
}