Characteristics and prognosis in patients with false-positive ST-elevation myocardial infarction in the ED

Clinical presentation and outcome of patients with ST-segment elevation myocardial infarction without culprit angiographic lesions

“…This is attributed to the high mortality rate associated with diagnoses such as aortic dissection, cardiogenic shock, and pulmonary embolus that were initially misdiagnosed as STEMIs. Other studies have shown similar mortality rates and have reported additional life-threatening non-STEMI diagnoses including subarachnoid hemorrhage, severe sepsis, intestinal ischemia, and esophageal perforation [11][12][13][14][15][16]18]. Therefore, in the absence of a culprit lesion in unstable patients presenting initially as a possible STEMI, further investigations and consideration of other lifethreatening diagnosis are required.…”

“…In previous studies, the prevalence of false-positive STEMI ranged from 5% to 36% [8,9,[13][14][15][16] depending on the definition of falsepositive STEMI and the process of Code STEMI activation. In our study, false-positive STEMI was defined as the presence of ST-segment elevation in the absence of a culprit lesion on coronary angiography.…”

“…The morphology of STE was classified as concave if the STsegment dipped below a straight line drawn between the J-point to the end of the ST-segment [12]. ST depression was classified as reciprocal if it was in the anterior or lateral territories for an inferior STE pattern, in the inferior territory for an anterior or lateral STE pattern, or in the anterior territory for a posterior STE pattern [13]. A culprit coronary lesion was defined as the presence of an acute total or subtotal occlusion of a coronary artery that correlates with the STE identified on the qualifying ECG [12].…”

Characteristics of ST Elevation Myocardial Infarction Patients Who Do Not Undergo Percutaneous Coronary Intervention After Prehospital Cardiac Catheterization Laboratory Activation

“…The rate of inappropriate or false positive activations range between 5 to 24% depending on the particular system in place for CCL activation (prehospital vs ED physician) in the published literature across the country. (20), (21)(22)(23) In an era when healthcare costs are scrutinized carefully, the monetary and human cost associated with an inappropriate CCL activation is not insignificant.…”

The What, When, Who, Why, How and Where of Myocardial Infarction With Non-Obstructive Coronary Arteries (MINOCA)

“…10 For example, acute ST-elevation MI (STEMI) registry studies have labeled patients presenting with acute ST elevation and nonobstructive CAD on angiography as a "false-positive STEMI diagnosis". 10, 11 In some cases this may be appropriate if the ECG is misinterpreted. However, if the patient exhibits new ST elevation with a significant troponin rise and non-obstructive CAD on angiography, they should be diagnosed as MIN-OCA.…”