Identifying false-positive ST-elevation myocardial infarction in emergency department patients
Nfor T, Kostopoulos L, Hashim H, Jan MF, Gupta A, Bajwa T, Allaqaband S. Identifying false-positive ST-elevation myocardial infarction in emergency department patients. J Emerg Med. 2012 Oct;43(4):561-7.
BACKGROUND: In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) within 90 min of door-to-balloon time, emergency cardiac catheterization laboratory activation protocols bypass routine clinical assessments, raising the possibility of more frequent catheterizations in patients with no culprit coronary lesion.
OBJECTIVE: To determine the incidence, predictors, and prognosis of false-positive STEMI.
METHODS: We followed a prospective cohort of patients diagnosed with STEMI by usual criteria receiving emergency cardiac catheterization with intention of primary PCI between January 2005 and December 2007 at a tertiary care center. False-positive STEMI was defined as absence of a clear culprit lesion on coronary angiography.
RESULTS: Of 489 patients who received emergency cardiac catheterization indicated for STEMI, 54 (11.0%, 95% confidence interval [CI] 8.3-13.8) had no culprit lesion on coronary angiography. Independent predictors of false-positive STEMI were absence of chest pain (odds ratio [OR] 18.2, 95% CI 3.7-90.1), no reciprocal ST-segment changes (OR 11.8, 95% CI 5.14-27.3), fewer than three cardiovascular risk factors (OR 9.79, 95% CI 4.0-23.8), and symptom duration longer than 6h (OR 9.2, 95% CI 3.6-23.7); all p
CONCLUSION: When the diagnosis of STEMI is in doubt, clinicians may use predictors to quickly reassess the likelihood of an alternative diagnosis.