J Korean Soc Emerg Med.  2016 Feb;27(1):36-42. 10.0000/jksem.2016.27.1.36.

Factors Associated with False-positive ST-segment Elevation Myocardial Infarction Activated by Emergency Physician

• Kang G
• Kim SH
• Hwang JH
• Oh SH
• Choi SP
• Park KN
• Youn CS

• KMID: 2191635
• DOI: http://doi.org/10.0000/jksem.2016.27.1.36

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.

Keyword

Myocardial infarction; Predictive value of tests; Differential diagnosis

MeSH Terms

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