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Pathophysiology of NSTEMI vs STEMI: Pathophysiologically, NSTEMI is somewhat different from STEMI. NSTEMI occurs by developing a complete occlusion of a minor coronary artery or a partial occlusion of a major coronary artery previously affected by atherosclerosis. This causes a partial thickness damage of heart muscle.
Because the ST segment on the ECG does not become elevated in this condition, it is called a non-ST-segment elevation myocardial infarction, or NSTEMI. When the blood clot that forms during ACS completely blocks the artery, all the heart muscle supplied by the artery begins to die. This, the most severe consequence of an ACS, is called a STEMI. In many cases, a STEMI is preceded (by hours, days or weeks) by unstable angina and/or an NSTEMI.