False Positive STEMI Activations in a Regional Network: Comprehensive Analysis and Clinical Impact. Results From the
Ander Regueiro1, Diego Fernández-Rodríguez2, Xavier Freixa1
1Servicio de Cardiología, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Insights
False-positive ST-segment elevation myocardial infarction (STEMI) diagnoses are common in networks. However, outcomes for true and false STEMI activations are similar, suggesting network optimization is key.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- STEMI network activation by non-cardiologists can reduce delays.
- However, this approach may increase false-positive STEMI diagnoses.
Purpose of the Study:
- To determine the prevalence of false-positive STEMI activations.
- To identify predictors of false-positive STEMI diagnoses.
- To assess the clinical impact of false-positive STEMI diagnoses within the Catalonian STEMI network (Codi Infart).
Main Methods:
- Analysis of 5701 STEMI network activations from January 2010 to December 2011.
- Classification of activations as appropriate based on ECG and clinical STEMI criteria.
- Definition of false positives using angiographic (no culprit artery) and clinical (non-STEMI discharge diagnosis) criteria.
Main Results:
- False-positive rates were 14.6% (angiographic) and 11.6% (clinical).
- Independent predictors included female sex, left bundle branch block, and prior myocardial infarction.
- Hospitals without PCI and patients with early complications also showed higher false-positive rates (clinical definition).
Conclusions:
- False-positive STEMI diagnoses are frequent within STEMI networks.
- In-hospital and 30-day mortality rates were similar for true-positive and false-positive STEMI patients.
- Optimizing STEMI network use requires careful assessment of modifiable predictors of false-positive diagnoses.
Introduction And Objectives:
ST-segment elevation myocardial infarction (STEMI) network activation by a noncardiologist reduces delay times but may increase the rate of false-positive STEMI diagnoses. We aimed to determine the prevalence, predictors, and clinical impact of false-positive activations within the Catalonian STEMI network (Codi Infart).
Methods:
From January 2010 through December 2011, all consecutive patients treated within the Codi Infart network were included. Code activations were classified as appropriate if they satisfied both electrocardiogram and clinical STEMI criteria. Appropriate activations were classified as false positives using 2 nonexclusive definitions: a) "angiographic" if a culprit coronary artery was not identified, and b) "clinical" if the discharge diagnosis was other than STEMI.
Results:
In total, 5701 activations were included. Appropriate activation was performed in 87.8% of the episodes. The rate of angiographic false positives was 14.6%, while the rate of clinical false positives was 11.6%. Irrespective of the definition, female sex, left bundle branch block, and previous myocardial infarction were independent predictors of false-positive STEMI diagnoses. Using the clinical definition, hospitals without percutaneous coronary intervention and patients with complications during the first medical contact also had a false-positive STEMI diagnoses rate higher than the mean. In-hospital and 30-day mortality rates were similar for false-positive and true-positive STEMI patients after adjustment for possible confounders.
Conclusions:
False-positive STEMI diagnoses were frequent. Outcomes were similar for patients with a true-positive or false-positive STEMI diagnosis treated within a STEMI network. The presence of any modifiable predictors of a false-positive STEMI diagnosis warrants careful assessment to optimize the use of STEMI networks.
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