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ECG clues for false ST-segment elevation myocardial infarction activations.

Akanksha Agrawal1, Marvin Lu1, Napatt Kanjanahattakij1

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Nearly 23% of ST-segment elevation myocardial infarction (STEMI) alerts were false alarms. Misdiagnoses were often due to left ventricular hypertrophy and right bundle branch block, highlighting the need for improved ECG interpretation training.

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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Diagnostic Imaging

Background:

  • Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is critical for timely treatment.
  • False STEMI activations lead to unnecessary cardiac catheterization, increasing risks and healthcare costs.

Purpose of the Study:

  • To analyze the causes of false STEMI alerts.
  • To identify electrocardiogram (ECG) differences between true and false STEMI diagnoses.

Main Methods:

  • Retrospective study of 361 'cath alerts' from January 2012 to December 2015.
  • Review of initial ECGs to differentiate true STEMI from false alarms.
  • Multivariate regression analysis to identify predictors of false STEMI.

Main Results:

  • 22.7% of STEMI alerts (82/361) were false positives.
  • Common misdiagnosis causes included left ventricular hypertrophy (LVH, 49%) and right bundle branch block (RBBB, 16%).
  • LVH and RBBB were independent predictors of false STEMI diagnoses.

Conclusions:

  • The incidence of false STEMI alerts was substantial (22.7%) at the study center.
  • Enhanced ECG interpretation training for emergency physicians is recommended.
  • Recognizing conditions like LVH, early repolarization, RBBB, and Brugada pattern can reduce false STEMI activations.