Abstract
Background
In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary
percutaneous coronary intervention (PCI) within 90 min of door-to-balloon time, emergency cardiac catheterization laboratory activation
protocols bypass routine clinical assessments, raising the possibility of more frequent
catheterizations in patients with no culprit coronary lesion.
Objective
To determine the incidence, predictors, and prognosis of false-positive STEMI.
Methods
We followed a prospective cohort of patients diagnosed with STEMI by usual criteria
receiving emergency cardiac catheterization with intention of primary PCI between
January 2005 and December 2007 at a tertiary care center. False-positive STEMI was
defined as absence of a clear culprit lesion on coronary angiography.
Results
Of 489 patients who received emergency cardiac catheterization indicated for STEMI,
54 (11.0%, 95% confidence interval [CI] 8.3–13.8) had no culprit lesion on coronary
angiography. Independent predictors of false-positive STEMI were absence of chest
pain (odds ratio [OR] 18.2, 95% CI 3.7–90.1), no reciprocal ST-segment changes (OR
11.8, 95% CI 5.14–27.3), fewer than three cardiovascular risk factors (OR 9.79, 95%
CI 4.0–23.8), and symptom duration longer than 6 h (OR 9.2, 95% CI 3.6–23.7); all p<0.001. Using predictors, we modeled a risk score that achieved 88% (95% CI 81–94%)
accuracy in identifying patients with negative coronary angiography. Among the false-positive
STEMI patients, 48.1% had other serious diagnoses related to their electrocardiographic
findings.
Conclusion
When the diagnosis of STEMI is in doubt, clinicians may use predictors to quickly
reassess the likelihood of an alternative diagnosis.
Keywords
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Article info
Publication history
Published online: January 30, 2012
Accepted:
September 28,
2011
Received in revised form:
May 16,
2011
Received:
February 28,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
