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A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

Positive predictive value of clinically suspected ST-segment elevation myocardial infarction using angiographic

Søren Becker1, Gro Chisholm, Michael Maeng

  • 1Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.

The American Journal of Cardiology
|June 18, 2013
PubMed

Insights

In Denmark, a significant number of suspected ST-segment elevation myocardial infarction (STEMI) cases were not confirmed by angiography. This highlights the risks of using fibrinolysis without definitive diagnosis in STEMI patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Emergency Medicine

Background:

  • Fibrinolysis is no longer used for ST-segment elevation myocardial infarction (STEMI) in Denmark since 2005.
  • Acute coronary angiography is standard for suspected STEMI cases in Denmark.
  • Assessing the accuracy of STEMI diagnosis is crucial for appropriate treatment selection.

Purpose of the Study:

  • To determine the positive predictive value of clinically suspected ST-segment elevation myocardial infarction (STEMI) in a real-world setting.
  • To evaluate the diagnostic accuracy of suspected STEMI when all patients undergo acute coronary angiography.
  • To identify patient subgroups with lower positive predictive values for STEMI.

Main Methods:

  • Retrospective evaluation of consecutive patients with suspected STEMI admitted to Aarhus University Hospital (September 2010 - August 2011).
  • Definition of conclusive STEMI as an identifiable culprit lesion confirmed by angiography.
  • Comparison of clinical characteristics between patients with and without conclusive STEMI.

Main Results:

  • Out of 615 suspected STEMI patients, 483 (79%) had conclusive STEMI.
  • Patients without conclusive STEMI were more likely to have diabetes mellitus, left bundle branch block, hypertension, or prior coronary artery bypass surgery.
  • Positive predictive values for STEMI were notably lower in patients with left bundle branch block (26%) and prior coronary artery bypass surgery (41%).

Conclusions:

  • A substantial proportion of patients suspected of STEMI do not have a confirmed culprit lesion upon angiography.
  • Conditions like left bundle branch block and prior coronary artery bypass surgery are associated with lower positive predictive values for STEMI.
  • These findings underscore the importance of acute angiography in avoiding unnecessary and potentially harmful fibrinolysis in patients with suspected STEMI.

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