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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
ECG clues for false ST-segment elevation myocardial infarction activations
Akanksha Agrawal1, Marvin Lu1, Napatt Kanjanahattakij1
1Departments of Internal Medicine.
Insights
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.
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.
Background:
Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is crucial for appropriate management. Catheterization for a false STEMI activation has risks including exposure to contrast agent and radiation, increased healthcare costs and delay in treatment of the primary medical condition.
Patients And Methods:
This was a single center retrospective study including all 'cath alerts' between January 2012 and December 2015. 'Cath alert' is a term used to activate the interventional cardiology team when STEMI is suspected by the emergency department physicians based on review of the initial ECG. We reviewed all STEMI alerts to understand ECG differences between true and false STEMI.
Results:
Our study population (N = 361) included 221 (61%) men and 140 (39%) women, with average age 60 ± 4.2 years. Among the 361 STEMI alerts, 82 (22.7%) did not have acute coronary syndrome. Common ECG causes of misdiagnosis included left ventricular hypertrophy (LVH, found in 40/82, 49%), early repolarization changes (20/82, 24%), right bundle branch block (RBBB) (13/82, 16%), and Brugada pattern (3/82, 4%). Multivariate regression analysis showed that LVH and RBBB were independent predictors of nonacute coronary syndrome false STEMI (odds ratio: 0.54; 95% confidence interval: 0.32-0.93; P = 0.03 for LVH, and odds ratio: 0.26, 95% confidence interval: 0.1-0.62, P = 0.004 for RBBB).
Conclusion:
The incidence of false STEMI alerts was almost 23% at our center. This number might be reduced with additional training of emergency department physicians in ECG interpretation, and recognition of common causes of misdiagnosis such as LVH, early repolarization changes, RBBB, and Brugada pattern.
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