You've seen it countless times: a patient walks into the ED with chest pain, and the EKG isn't screaming STEMI. But in follow-up, they end up having a massive myocardial infarction. What is the hidden culprit lurking behind those non-alarming EKGs? Welcome to the Occlusive Myocardial Infarction (OMI) world, where traditional STEMI criteria fall short, and a new paradigm shifts our approach to acute cardiac ischemia.