Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary
James M McCabe1, Ehrin J Armstrong, Ameya Kulkarni
1Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mccabe@aya.yale.edu
Insights
Over a third of ST-segment elevation myocardial infarction (STEMI) activations for primary percutaneous coronary intervention (PCI) were false positives. Patient factors like left ventricular hypertrophy and prior drug abuse increased false activation odds.
Area of Science:
- Cardiology
- Emergency Medicine
- Interventional Cardiology
Background:
- Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) rapidly activates cardiac catheterization labs.
- Emphasis on speed may increase false-positive STEMI activations.
Purpose of the Study:
- To evaluate the frequency and predictors of false-positive STEMI activations.
- To identify patient-level characteristics associated with unnecessary primary PCI referrals.
Main Methods:
- Analysis of consecutive patients referred for primary PCI for suspected STEMI across two centers (Oct 2008 - Apr 2011).
- Defined false-positive STEMI activation as absence of a culprit lesion or confirmed STEMI.
- Used logistic regression to identify associated clinical and electrocardiographic factors.
Main Results:
- 146 of 411 (36%) STEMI activations were false-positive.
- Common false-positive diagnoses included structural heart disease and heart failure.
- Independent predictors of false-positive STEMI activation included LVH, prior coronary disease, and drug abuse; decreasing odds were associated with higher BMI and angina.
Conclusions:
- A significant proportion of emergency department STEMI activations do not result in primary PCI.
- Patient-specific factors are associated with an increased likelihood of false-positive STEMI activations, suggesting potential for improved diagnostic accuracy.
Background:
Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations.
Methods:
We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. "False-positive STEMI activation" was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model.
Results:
Of 411 STEMI activations by emergency physicians, 146 (36%) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95% CI, 1.55-6.40; P=.001), a history of coronary disease (AOR, 1.93; 95% CI, 1.04-3.59; P=.04), or prior illicit drug abuse (AOR, 2.67; 95% CI, 1.13-6.26; P=.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a false-positive activation (AOR, 0.91; 95% CI, 0.86-0.97; P=.004), as did angina at presentation (AOR, 0.28; 95% CI, 0.14-0.57; P < .001).
Conclusions:
More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of false-positive STEMI activation.
More Related Videos
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Coronary Artery Disease III: Clinical Manifestations
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...