Etiologies and Predictors of ST-Segment Elevation Myocardial Infarction.
10.4070/kcj.2013.43.6.370
- Author:
Myung Hwan BAE
1
;
Sang Soo CHEON
;
Joon Hyuk SONG
;
Se Yong JANG
;
Won Suk CHOI
;
Kyun Hee KIM
;
Sun Hee PARK
;
Jang Hoon LEE
;
Dong Heon YANG
;
Hun Sik PARK
;
Yongkeun CHO
;
Shung Chull CHAE
Author Information
1. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea. choyk@mail.knu.ac.kr
- Publication Type:Original Article
- Keywords:
Myocardial infarction;
False positive reactions
- MeSH:
Cardiomyopathies;
Catheterization;
Catheters;
Chest Pain;
Coronary Vessels;
Electrocardiography;
False Positive Reactions;
Humans;
Hypertrophy, Left Ventricular;
Logistic Models;
Myocardial Infarction;
Myocarditis;
Prevalence;
Spasm
- From:Korean Circulation Journal
2013;43(6):370-376
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND AND OBJECTIVES: Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for the appropriate management of patients. We investigated the prevalence, etiologies and predictors of false-positive diagnosis of STEMI and subsequent inappropriate catheterization laboratory activation in patients with presumptive diagnosis of STEMI. SUBJECTS AND METHODS: Four hundred fifty-five consecutive patients (62+/-13 years, 345 males) with presumptive diagnosis of STEMI between August 2008 and November 2010 were included. RESULTS: A false-positive diagnosis of STEMI was made in 34 patients (7.5%) with no indication of coronary artery lesion. Common causes for the false-positive diagnosis were coronary spasm in 10 patients, left ventricular hypertrophy in 5 patients, myocarditis in 4 patients, early repolarization in 3 patients, and previous myocardial infarction and stress-induced cardiomyopathy in 2 patients each. In multivariate logistic regression analysis, symptom-to-door time >12 hours {odds ratio (OR) 4.995, 95% confidence interval (CI) 1.384-18.030, p=0.014}, presenting symptom other than chest pain (OR 7.709, 95% CI 1.255-39.922, p=0.027), absence of Q wave (OR 9.082, CI 2.631-31.351, p<0.001) and absence of reciprocal changes on electrocardiography (ECG) (OR 17.987, CI 5.295-61.106, p<0.001) were independent predictors of false-positive diagnosis of STEMI. CONCLUSION: In patients whom STEMI was planned for primary coronary intervention, the false-positive diagnosis of STEMI was not rare. Correct interpretation of ECGs and consideration of ST-segment elevation in conditions other than STEMI may reduce inappropriate catheterization laboratory activation.
