Conditions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous
Y L Gu1, T Svilaas, I C C van der Horst
1Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Insights
A small percentage of patients undergoing primary percutaneous coronary intervention (PCI) for suspected ST-segment elevation myocardial infarction (STEMI) have other diagnoses. These STEMI mimics can have serious outcomes, highlighting the need for careful clinical evaluation.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is critical for timely treatment.
- A small but significant number of patients with suspected STEMI are ultimately diagnosed with other conditions.
- Existing literature lacks a contemporary systematic analysis of these STEMI mimics.
Purpose of the Study:
- To determine the incidence, clinical characteristics, and outcomes of patients with suspected STEMI who were referred for primary percutaneous coronary intervention (PCI) but received a different final diagnosis.
- To identify factors differentiating STEMI mimics from actual STEMI cases.
Main Methods:
- A consecutive series of 820 patients with suspected STEMI referred for primary PCI were analyzed.
- Data on clinical characteristics, final diagnoses, and outcomes were collected from patient charts and databases.
- The study period was from January 2004 to July 2005 at a university medical center.
Main Results:
- Nineteen patients (2.3%) were diagnosed with conditions other than STEMI, including (myo)pericarditis, aortic dissection, and subarachnoid hemorrhage.
- Patients with STEMI mimics were less likely to report angina symptoms, smoking history, or a family history of cardiovascular disease.
- The 30-day mortality rate for patients with STEMI mimics was 16%.
Conclusions:
- Conditions mimicking STEMI occur in 2.3% of patients referred for primary PCI.
- Maintaining a high clinical suspicion for alternative diagnoses is essential in suspected STEMI cases.
- Prompt identification and management of STEMI mimics are crucial due to their potential for severe outcomes.
Abstract:
BACKGROUND/OBJECTIVES.: A rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is mandatory for optimal treatment. However, a small proportion of patients with suspected STEMI suffer from other conditions. Although case reports have described these conditions, a contemporary systematic analysis is lacking. We report the incidence, clinical characteristics and outcome of patients with suspected STEMI referred for primary percutaneous coronary intervention (PCI) with a final diagnosis other than STEMI. METHODS.: From January 2004 to July 2005, 820 consecutive patients were included with suspected STEMI who were referred for primary PCI to a university medical centre, based on a predefined protocol. Clinical characteristics, final diagnosis and outcome were obtained from patient charts and databases. RESULTS.: In 19 patients (2.3%), a final diagnosis other than myocardial infarction was established: coronary aneurysm (n=1), (myo)pericarditis (n=5), cardiomyopathy (n=2), Brugada syndrome (n=1), aortic stenosis (n=1), aortic dissection (n=3), subarachnoidal haemorrhage (n=2), pneumonia (n=1), chronic obstructive pulmonary disease (n=1), mediastinal tumour (n=1), and peritonitis after recent abdominal surgery (n=1). These patients less often reported previous symptoms of angina (p<0.001), smoking (p<0.05) and a positive family history of cardiovascular diseases (p<0.05) than STEMI patients. Mortality at 30 days was 16%. CONCLUSION.: A 2.3% incidence of conditions mimicking STEMI was found in patients referred for primary PCI. A high clinical suspicion of conditions mimicking STEMI remains necessary. (Neth Heart J 2008;16:325-31.).
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