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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.
ST-segment is a portion of ECG; its elevation indicates full thickness injury of heart muscle. Absence of ST-segment elevation in NSTEMI is understood to involve less than full thickness (partial thickness) damage of heart muscle. Therefore, NSTEMI is less severe type of heart attack compared to STEMI (ST-segment elevation myocardial infarction) in which full thickness damage of heart muscle develops.