Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature
Chun Shing Kwok1,2, Sadie Bennett2, Ziyad Azam2
1From the School of Medicine, Keele University, Stoke-on-Trent, United Kingdom.
Background:
Despite the availability of tests to diagnose acute myocardial infarction (AMI), cases are still missed.
Methods:
We systematically reviewed the literature to determine how missed AMI has been defined, the reported rates of misdiagnosed AMI, the outcomes patients with misdiagnosed AMI have, what diagnosis was initially suspected in missed AMI cases, and what factors are associated with misdiagnosed AMI. We searched MEDLINE and EMBASE in September 2020 for studies that evaluated missed AMI. Data were extracted from studies that met the inclusion criteria and the results were narratively synthesized.
Results:
A total of 15 studies were included in this review. The number of patients with missed AMI in individual studies ranged from 64 to 4707. There was no consistently used definition for misdiagnosed AMI, but most studies reported rates of approximately 1%-2%. Compared with AMI that was recognized, 1 study found no difference in mortality for misdiagnosed AMI at 30 days and 1 year. The common initial misdiagnoses that subsequently had AMI were ischemic heart disease, nonspecific chest pain, gastrointestinal disease, musculoskeletal pain, and arrhythmias. Reasons for missed AMI include incorrect electrocardiogram interpretation and failure to order appropriate diagnostic tests. Hospitals in rural areas and those with a low proportion of classical chest pain patients that turned out to have AMI were at greater risk of missed AMI.
Conclusions:
Misdiagnosed AMI is an unfortunate part of everyday clinical practice and better training in electrocardiogram interpretation, and education about atypical presentations of AMI may reduce the number of misdiagnosed AMIs.
Insights
Missed acute myocardial infarction (AMI) occurs in 1-2% of cases, often due to misdiagnosis of other conditions. Improved electrocardiogram interpretation and awareness of atypical symptoms can help reduce these errors.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Practice
Background:
- Despite diagnostic tools, acute myocardial infarction (AMI) is sometimes missed in clinical practice.
- This highlights a critical gap in timely and accurate diagnosis of cardiac events.
Purpose of the Study:
- To systematically review literature on missed AMI.
- To define how missed AMI is characterized, its incidence, patient outcomes, initial misdiagnoses, and associated risk factors.
Main Methods:
- A systematic literature search was conducted in MEDLINE and EMBASE in September 2020.
- Included studies evaluating missed AMI were narratively synthesized.
Main Results:
- Fifteen studies were reviewed, with missed AMI rates around 1-2%.
- Common initial misdiagnoses included ischemic heart disease, nonspecific chest pain, and gastrointestinal issues.
- Factors contributing to missed AMI involved ECG interpretation errors and delayed diagnostic testing, with rural hospitals being at higher risk.
Conclusions:
- Misdiagnosed AMI remains a challenge in clinical settings.
- Enhanced training in ECG interpretation and recognizing atypical AMI presentations are crucial for reducing diagnostic errors.
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