Risk score to predict false-positive ST-segment elevation myocardial infarction in the emergency department: a
Ji Hoon Kim1, Yun Ho Roh2, Yoo Seok Park1
1Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 03722, Seoul, Republic of Korea.
Insights
A new prediction model helps identify false-positive ST-segment elevation myocardial infarction (STEMI) cases, reducing unnecessary primary percutaneous coronary intervention (PCI). This model aids clinicians in making faster, more informed decisions for STEMI patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Diagnostics
Background:
- ST-segment elevation myocardial infarction (STEMI) necessitates prompt primary percutaneous coronary intervention (PCI).
- A subset of patients present with ST elevation on electrocardiography (ECG) but do not have myocardial infarction, leading to false-positive diagnoses.
- Accurate identification of false-positive STEMI is crucial to avoid unnecessary invasive procedures.
Purpose of the Study:
- To determine the frequency of false-positive STEMI in patients undergoing a critical pathway (CP) for STEMI.
- To develop and validate a prediction model for identifying false-positive STEMI cases.
Main Methods:
- A prediction model was developed using a derivation cohort from emergency departments utilizing a STEMI CP protocol.
- The model was subsequently validated in internal and external validation cohorts.
- Key independent predictors for false-positive STEMI were identified, including age, chest pain characteristics, and ECG findings.
Main Results:
- The incidence of false-positive STEMI was 16.3% among eligible patients.
- Independent predictors included younger age (<65 years), absence of chest pain, atypical chest pain, lack of reciprocal changes, and concave-morphology ST elevation.
- The developed risk score demonstrated good predictive performance with areas under the ROC curve of 0.839 and 0.820 in validation cohorts, and high negative predictive values (94.9% and 96.7%).
Conclusions:
- A simplified risk score was established to predict false-positive STEMI, aiding clinical decision-making.
- The model shows potential to improve the rationale behind rapid decisions in suspected STEMI cases.
- Further large-scale validation and prospective studies are recommended to confirm the model's clinical utility in reducing inappropriate primary PCI.
Background:
The best treatment approach for ST-segment elevation myocardial infarction (STEMI) is prompt primary percutaneous coronary intervention (PCI). However, some patients show ST elevation on electrocardiography (ECG), but do not have myocardial infarction. We sought to identify the frequency of and to develop a prediction model for false-positive STEMI.
Methods:
This study was conducted in the emergency departments (EDs) of two hospitals using the same critical pathway (CP) protocol to treat STEMI patients with primary PCI. The prediction model was developed in a derivation cohort and validated in internal and external validation cohorts.
Results:
Of the CP-activated patients, those for whom ST elevation did not meet the ECG criteria were excluded. Among the patients with appropriate ECG patterns, the incidence of false-positive STEMI in the entire cohort was 16.3%. Independent predictors extracted from the derivation cohort for false-positive STEMI were age < 65 years (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.35-4.89), no chest pain (OR, 12.04; 95% CI, 5.92-25.63), atypical chest pain (OR, 7.40; 95% CI, 3.27-17.14), no reciprocal change (OR, 4.80; 95% CI, 2.54-9.51), and concave-morphology ST elevation (OR, 14.54; 95% CI, 6.87-34.37). Based on the regression coefficients, we established a simplified risk score. In the internal and external validation cohorts, the areas under the receiver operating characteristic curves for our risk score were 0.839 (95% CI, 0.724-0.954) and 0.820 (95% CI, 0.727-0.913), respectively; the positive predictive values were 40.9% and 22.0%, respectively; and the negative predictive values were 94.9% and 96.7%, respectively.
Discussion:
Our prediction model would help them make rapid decisions with better rationale.
Conclusion:
We devised a model to predict false-positive STEMI. Larger-scale validation studies are needed to validate our model, and a prospective study to determine whether this model is effective in reducing improper primary PCI in actual clinical practice should be performed.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
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...