Prevalence and Factors Associated With False-Positive ST-Segment Elevation Myocardial Infarction Diagnoses at Primary Percutaneous Coronary Intervention–Capable Centers

McCabe, James M.; Armstrong, Ehrin J.; Kulkarni, Ashwini; Hoffmayer, Kurt S.; Bhave, Prashant D.; Garg, Sonia; Patel, Ateet; MacGregor, John S.; Hsue, Priscilla Y.; Stein, John C.; Kinlay, Scott; Ganz, Patricia A.

doi:10.1001/archinternmed.2012.945

Cited by 117 publications

(87 citation statements)

References 30 publications

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“…9,11,22 Second, the presence of equivocal ECG findings (such as presumed new left bundle branch block or isolated posterior MI) was the strongest factor limiting direct cath lab transfer in our multivariable model. The United States health system tolerates a certain degree of false activation of the cath lab for suspected STEMI patients 23,24 ; this threshold may need to CI indicates confidence interval; cath, catheterization; ED, emergency department; and OR, odds ratio. *Odds of the outcome in patients directly transferred to the cath laboratory versus patients transferred to an ED/ward.…”

Section: Discussionmentioning

confidence: 99%

Direct Transfer From the Referring Hospitals to the Catheterization Laboratory to Minimize Reperfusion Delays for Primary Percutaneous Coronary Intervention

Anderson

French

Peng

et al. 2015

Circ: Cardiovascular Interventions

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Background-For patients with ST-segment-elevation myocardial infarction (STEMI) requiring interhospital transfer for primary percutaneous coronary intervention, direct transfer from the STEMI referral hospital to the catheterization laboratory (cath lab) at the STEMI receiving hospital may expedite reperfusion, but can be logistically challenging. 0001).After multivariable logistic regression, patients transferred directly to the cath lab also had lower adjusted mortality risk (odds ratio 0.58, 95% confidence interval 0.51-0.66, P<0.0001). Cardiogenic shock, heart failure signs/symptoms, and nonsystem reasons for reperfusion delay were present in 11%, 15%, and 28% of patients transferred first to the emergency department/ward, respectively. The association of direct cath lab transfer with lower mortality persisted after excluding patients with these reasons for delay to primary percutaneous coronary intervention (adjusted odds ratio 0.62, 95% confidence interval 0.46-0.84, P=0.002). Conclusions-Direct transfer of STEMI patients to the cath lab for primary percutaneous coronary intervention was associated with significantly faster reperfusion and lower mortality risk compared with transfer first to the emergency department/ward. (Circ Cardiovasc Interv. 2015;8:e002477.

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Section: Discussionmentioning

confidence: 99%

Direct Transfer From the Referring Hospitals to the Catheterization Laboratory to Minimize Reperfusion Delays for Primary Percutaneous Coronary Intervention

Anderson

French

Peng

et al. 2015

Circ: Cardiovascular Interventions

View full text Add to dashboard Cite

show abstract

“…Finally, only one study I am aware of has addressed the problem of false positive activations appropriately [19]. In this study, a true positive required a flow grade less than thrombolysis in myocardial infarction (TIMI) grade 3 flow in at least one artery, and found that 36 % of cases were false positive activations.…”

Section: Pseudoinfarction Missed Stemi and Appropriate Cath Lab Actmentioning

confidence: 93%

Updates on the Electrocardiogram in Acute Coronary Syndromes

Smith

2012

Curr Emerg Hosp Med Rep

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The electrocardiogram (ECG) is the initial test in patients with suspected ACS. The ECG is the defining element of ST-segment elevation myocardial infarction (STEMI). Its most important use is in the detection of acute coronary obstruction, and it is the most important, cost-effective, and immediately available initial test in the decision for emergency reperfusion therapy. There is a recent interest in refining the sensitivity and specificity of the ECG for coronary occlusion, and thus for identifying subtle STEMI, as well as in recognizing pseudoinfarction patterns and thus avoiding false positive cath lab activations. Studies assessing the accuracy of cath lab activation, the differentiation of precordial ST-segment elevation due to normal variant from that of anterior STEMI, the diagnosis of STEMI in the presence of left bundle branch block, the differentiation of benign inferior ST-segment elevation from that of inferior STEMI, and the importance of ST-segment elevation in lead aVR will be discussed.

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“…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.…”

Section: Clinical Recognitionmentioning

confidence: 99%

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

Pasupathy

Tavella

Beltrame

2016

Circ J

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Prevalence and Factors Associated With False-Positive ST-Segment Elevation Myocardial Infarction Diagnoses at Primary Percutaneous Coronary Intervention–Capable Centers

Abstract: More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of false-positive STEMI activation.

Cited by 117 publications

References 30 publications

Direct Transfer From the Referring Hospitals to the Catheterization Laboratory to Minimize Reperfusion Delays for Primary Percutaneous Coronary Intervention

Direct Transfer From the Referring Hospitals to the Catheterization Laboratory to Minimize Reperfusion Delays for Primary Percutaneous Coronary Intervention

Updates on the Electrocardiogram in Acute Coronary Syndromes

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

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