Characteristics and prognosis in patients with false-positive ST-elevation myocardial infarction in the ED
Sheng-Liang Chung1, Meng-Huan Lei, Chao-Chin Chen
1Division of Cardiology, Department of Internal Medicine, Lotung Poh-Ai Hospital, Luodong Township, Yilan County 26546, Taiwan (ROC).
Insights
False-positive ST-segment elevation myocardial infarction (STEMI) occurs in 10.4% of cases. Careful clinical and electrocardiogram evaluation can help prevent unnecessary cardiac catheterization in these patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- ST-segment elevation (STE) can be caused by conditions other than acute myocardial infarction (MI).
- Distinguishing true STEMI from non-MI causes of STE is crucial for appropriate patient management.
Purpose of the Study:
- To determine the prevalence, etiology, clinical presentation, electrocardiographic features, and outcomes of false-positive STEMI.
- To identify factors that differentiate false-positive STEMI from true STEMI.
Main Methods:
- Retrospective case-control study.
- Analysis of 297 patients undergoing emergent coronary angiography for suspected STEMI from January 2004 to December 2010.
- Comparison of clinical and electrocardiographic data between false-positive and true-positive STEMI groups.
Main Results:
- False-positive STEMI was diagnosed in 10.4% of patients (31/297).
- False-positive STEMI patients presented less frequently with typical chest pain (58.1% vs. 87.6%) and more often showed diffuse STE (19.4% vs. 0.38%), concave STE (51.6% vs. 24.1%), and no reciprocal ST depression (64.5% vs. 19.2%).
- In-hospital major adverse events did not differ significantly between false-positive and true-positive STEMI groups.
Conclusions:
- False-positive STEMI is a significant diagnostic consideration.
- Thorough clinical assessment and electrocardiogram interpretation are vital to potentially avoid unnecessary cardiac catheterization procedures.
Background:
There are several causes of ST-segment elevation (STE) besides acute myocardial infarction (MI).
Objectives:
We design this study to determine the prevalence, etiology, clinical manifestation, electrocardiographic characteristics, and outcome in patients with false-positive STEMI.
Methods:
This is a retrospective case-control study design. At our emergency department, 297 patients who underwent emergent coronary angiography for suspected STEMI were enrolled from January 2004 to December 2010.
Results:
Of the 297 patients who underwent coronary angiography, 31 patients (10.4%) did not have a clear culprit coronary lesion and were classified as false-positive STEMI. False-positive STEMI patients had a lower incidence of typical chest pain or chest tightness (58.1% vs 87.6%, P < .001). Inferior STE occurred significantly more often in the patients with true-positive STEMI (49.6% vs 25.8%, P = .012), and diffuse STE, more often in the patients with false-positive STEMI (19.4% vs 0.38%, P = .001). Total height of STE was lower in false-positive STEMI patients (7.5 ± 4.9 vs 10.9 ± 7.9 mm, P = .002) if excluding 5 patients of marked STE just after cardiopulmonary resuscitation. Concave STE and no reciprocal ST-segment depression occurred more often in false-positive STEMI patients (51.6% vs 24.1%, P = .001; 64.5% vs 19.2%, P < .001). There was no significant difference of in-hospital major adverse events in the patients with false-positive and true-positive STEMI.
Conclusions:
The diagnosis of false-positive STEMI is not uncommon. Detailed clinical evaluation and electrocardiogram interpretation may avoid partly unnecessary catheterization laboratory activation.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Myocarditis II: Clinical Features and Diagnostic Tests
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:29Angina III: Clinical Manifestations and Assessment