Factors Associated with False-positive ST-segment Elevation Myocardial Infarction Activated by Emergency Physician.
- Author:
Goorahk KANG
1
;
Soo Hyun KIM
;
Ji Hyeon HWANG
;
Sang Hoon OH
;
Seung Pill CHOI
;
Kyu Nam PARK
;
Chun Song YOUN
Author Information
1. Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. ycs1005@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Myocardial infarction;
Predictive value of tests;
Differential diagnosis
- MeSH:
Angiography;
Cardiac Catheterization;
Cardiac Catheters;
Cardiomyopathies;
Chest Pain;
Coronary Angiography;
Coronary Disease;
Diagnosis;
Diagnosis, Differential;
Electrocardiography;
Emergencies*;
Emergency Service, Hospital;
Heart Failure;
Myocardial Infarction*;
Odds Ratio;
Predictive Value of Tests;
Spasm
- From:Journal of the Korean Society of Emergency Medicine
2016;27(1):36-42
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Rapid activation of the cardiac catheterization laboratory (CCL) is fundamental in the treatment of ST-segment elevation myocardial infarction (STEMI), and it is recommended that emergency department physicians activate CCL as soon as possible, however false positive activation is a major concern. The aim of this study is to assess the relationship between false positive activation and clinical factors available at the time of diagnosis. METHODS: All subjects with CCL activation by an emergency physician between August 2009 and May 2012 were included in this study. False-positive CCL activation was defined as absence of a clear culprit lesion on coronary angiography or by assessment of electrocardiographic and biomarker data in the absence of angiography. RESULTS: Of 222 STEMI activations by emergency physicians, 55 (25%) were false-positive STEMI. Coronary spasm, cardiomyopathy, known CAD, and heart failure were the most common diagnoses among false-positive STEMI. A history of cardiomyopathy (adjusted odds ratio, 13.393; 95% CI, 2.550-70.334; p=0.002), systolic blood pressure<100 mmHg at presentation (adjusted odds ratio, 2.817; 95% CI, 1.129-7.026; p=0.026), no chest pain on admission (adjusted odds ratio, 2.460; 95% CI, 1.162-5.209; p=0.019), and prior coronary disease (adjusted odds ratio, 3.966; 95% CI, 1.828-8.606; p<0.001) independently increased the odds of false-positive STEMI activations. CONCLUSION: False-positive CCL activations were relatively common according to the definition in this study. Various patient-level characteristics were significantly associated with false-positive CCL activation.
