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

Zhu, Tina; Huitema, Ashlay A.; Alemayehu, Mistre; Allegretti, M.; Chomicki, C.; Yadegari, Andrew; Lavi, Shahar

doi:10.1016/j.carrev.2015.04.004

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…However, Barnes et al suggested that during their study period, reduced door-to-balloon time was accompanied by increased negative results of primary PCI [7]. Patients with false-positive STEMI have been reported to have relatively poor outcomes, because several foetal pathologic conditions such as aortic dissection, pulmonary thromboembolism, and cerebral haemorrhage that should be diagnosed without delay can show ST elevation on ECG [11, 12, 19, 27]. This is the time to focus on how we can reduce the incidence of negative primary PCI, rather than just speed up the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…For the shape of the ST elevation, we determined whether the morphology was concave based on the line from the J point to the end of the ST segment [10]. ST depression was recognized as a reciprocal change if it was in the anterior or lateral areas for inferior ST elevation, in the inferior area for anterior or lateral ST elevation, or in the anterior area for posterior ST elevation [19]. We also checked for the presence of a Q wave and left ventricular hypertrophy.…”

Section: Methodsmentioning

confidence: 99%

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Risk score to predict false-positive ST-segment elevation myocardial infarction in the emergency department: a retrospective analysis

Kim

Roh

Park

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundThe best treatment approach for ST-segment elevation myocardial infarction (STEMI) is prompt primary percutaneous coronary intervention (PCI). However, some patients show ST elevation on electrocardiography (ECG), but do not have myocardial infarction. We sought to identify the frequency of and to develop a prediction model for false-positive STEMI.MethodsThis study was conducted in the emergency departments (EDs) of two hospitals using the same critical pathway (CP) protocol to treat STEMI patients with primary PCI. The prediction model was developed in a derivation cohort and validated in internal and external validation cohorts.ResultsOf the CP-activated patients, those for whom ST elevation did not meet the ECG criteria were excluded. Among the patients with appropriate ECG patterns, the incidence of false-positive STEMI in the entire cohort was 16.3%. Independent predictors extracted from the derivation cohort for false-positive STEMI were age < 65 years (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.35–4.89), no chest pain (OR, 12.04; 95% CI, 5.92–25.63), atypical chest pain (OR, 7.40; 95% CI, 3.27–17.14), no reciprocal change (OR, 4.80; 95% CI, 2.54–9.51), and concave-morphology ST elevation (OR, 14.54; 95% CI, 6.87–34.37). Based on the regression coefficients, we established a simplified risk score. In the internal and external validation cohorts, the areas under the receiver operating characteristic curves for our risk score were 0.839 (95% CI, 0.724–0.954) and 0.820 (95% CI, 0.727–0.913), respectively; the positive predictive values were 40.9% and 22.0%, respectively; and the negative predictive values were 94.9% and 96.7%, respectively.DiscussionOur prediction model would help them make rapid decisions with better rationale.ConclusionWe devised a model to predict false-positive STEMI. Larger-scale validation studies are needed to validate our model, and a prospective study to determine whether this model is effective in reducing improper primary PCI in actual clinical practice should be performed.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Risk score to predict false-positive ST-segment elevation myocardial infarction in the emergency department: a retrospective analysis

Kim

Roh

Park

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…1,[6][7][8][9] However, incorrect ECG interpretation may lead to false activation, unnecessary procedures, and delay in diagnosis of patients who may have other serious conditions. [10][11][12][13][14] We have previously shown that the diagnostic accuracy of STEMI interpretation by healthcare providers is linked to CJC Open 1 (2019) 28e34 exposure to ECG reading, with significant improvement when more than 20 ECGs are read per week. 2 This improvement was seen regardless of previous training or current level of expertise, thereby making it a potentially useful target in improving ECG interpretation across a heterogeneous population of healthcare providers.…”

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confidence: 99%

Improving Electrocardiography Diagnostic Accuracy in Emergency Medical Services Personnel

et al. 2019

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Background: Accuracy of electrocardiogram (ECG) interpretation is important for identification of ST-elevation myocardial infarction (STEMI) by Emergency Medical Services (EMS) personnel who recognize STEMI in the field and activate the coronary catheterization laboratory. According to previous research, there is improvement in diagnosis of STEMIs for healthcare providers who read an average of > 20 ECGs per week. This study evaluated the effectiveness of online ECG modules on improving diagnostic accuracy. Methods: EMS personnel received 25 ECGs per week to interpret via an online program. Diagnostic accuracy was assessed for improvement via completion of an ECG evaluation package before and after the intervention. Job satisfaction data were collected to determine the impact of the educational initiative. Results: A total of 64 participants completed the study. Overall, there was an improvement in ECG diagnostic accuracy from 50.8% to 61.2% (95% confidence interval [CI], 7.7-13.2; P < 0.0001). Specifically, there was significant improvement in the diagnosis of STEMI (8.5%; 95% CI, 4.9-12.3; P < 0.003) and supraventricular tachycardia (39.0%; R ESUM E

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“…Misinterpretation of ECG findings is a common cause of FP CCLA [12,21]. Some FP CCLAs may be unavoidable, including patients having takotsubo cardiomyopathy, pericarditis, or early repolarization syndrome [8,10,23,24]. In the study of Larson et al .…”

Section: Discussionmentioning

confidence: 99%

Likelihood of myocardial infarction, revascularization and death following catheterization laboratory activation in patients with vs. without both chest pain and ST elevation

Puleo

Salen

Manda

et al. 2020

Coronary Artery Disease

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Background Emergent cardiac catheterization laboratory activation (CCLA) for patients with suspected ST-elevation myocardial infarction (STEMI) is employed to expedite acute revascularization (AR). The incidence of false-positive CCLA, in which AR is not performed, remains high. The combination of chest pain (CP) and electrocardiographic ST elevation (STE) are the hallmarks of STEMI. However, CCLA is sometimes initiated for patients lacking this combination. The study objective was to quantify the difference in likelihood of AR and mortality in patients with vs. without both CP and STE. Methods Retrospective analysis of 1621 consecutive patients for whom CCLA was initiated in a six-hospital network. We assessed the likelihood of acute myocardial infarction (AMI), presence of a culprit lesion (CL), performance of AR, and hospital mortality among patients with both CP and STE (+CP/+STE) compared with patients lacking one or both [non(CP/STE)]. Results 87.0% of patients presented with CP, 82.4% with STE, and 73.7% with both. Among +CP/+STE patients, AMI was confirmed in 90.4%, a CL in 88.9%, and AR performed in 83.1%. The corresponding values among non(CP/STE) patients were 35.8, 31.9, and 28.1%, respectively ( P < 0.0001 for each). Nevertheless, mortality among non(CP/STE) patients was three-fold higher than in +CP/+STE patients (13.3% vs. 4.5%; P < 0.0001), with non-coronary deaths 24-fold more likely. Conclusion Patients lacking the combination of CP and STE have a markedly lower likelihood of AMI and AR than +CP/+STE patients, but significantly higher mortality. Protocols aimed at rapid, focused evaluation of non(CP/STE) patients prior to CCLA are needed.

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

Cited by 5 publications

References 20 publications

Risk score to predict false-positive ST-segment elevation myocardial infarction in the emergency department: a retrospective analysis

Risk score to predict false-positive ST-segment elevation myocardial infarction in the emergency department: a retrospective analysis

Improving Electrocardiography Diagnostic Accuracy in Emergency Medical Services Personnel

Likelihood of myocardial infarction, revascularization and death following catheterization laboratory activation in patients with vs. without both chest pain and ST elevation

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