ECG clues for false ST-segment elevation myocardial infarction activations

Autor: Napatt Kanjanahattakij, Marvin Lu, Vincent M. Figueredo, Hee Do Jeon, Gregg S. Pressman, Abel Romero-Corral, Akanksha Agrawal
Rok vydání: 2019
Předmět:
Male
Acute coronary syndrome
medicine.medical_specialty
Cardiac Catheterization
Benign early repolarization
030204 cardiovascular system & hematology
Unnecessary Procedures
Diagnosis
Differential
03 medical and health sciences
Electrocardiography
0302 clinical medicine
Predictive Value of Tests
Risk Factors
Internal medicine
medicine
ST segment
Humans
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Acute Coronary Syndrome
Diagnostic Errors
Aged
Retrospective Studies
Philadelphia
Interventional cardiology
medicine.diagnostic_test
business.industry
General Medicine
Emergency department
Right bundle branch block
Middle Aged
medicine.disease
Cardiology
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Emergency Service
Hospital
Zdroj: Coronary artery disease. 30(6)
ISSN: 1473-5830
Popis: Background Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is crucial for appropriate management. Catheterization for a false STEMI activation has risks including exposure to contrast agent and radiation, increased healthcare costs and delay in treatment of the primary medical condition. Patients and methods This was a single center retrospective study including all 'cath alerts' between January 2012 and December 2015. 'Cath alert' is a term used to activate the interventional cardiology team when STEMI is suspected by the emergency department physicians based on review of the initial ECG. We reviewed all STEMI alerts to understand ECG differences between true and false STEMI. Results Our study population (N = 361) included 221 (61%) men and 140 (39%) women, with average age 60 ± 4.2 years. Among the 361 STEMI alerts, 82 (22.7%) did not have acute coronary syndrome. Common ECG causes of misdiagnosis included left ventricular hypertrophy (LVH, found in 40/82, 49%), early repolarization changes (20/82, 24%), right bundle branch block (RBBB) (13/82, 16%), and Brugada pattern (3/82, 4%). Multivariate regression analysis showed that LVH and RBBB were independent predictors of nonacute coronary syndrome false STEMI (odds ratio: 0.54; 95% confidence interval: 0.32-0.93; P = 0.03 for LVH, and odds ratio: 0.26, 95% confidence interval: 0.1-0.62, P = 0.004 for RBBB). Conclusion The incidence of false STEMI alerts was almost 23% at our center. This number might be reduced with additional training of emergency department physicians in ECG interpretation, and recognition of common causes of misdiagnosis such as LVH, early repolarization changes, RBBB, and Brugada pattern.
Databáze: OpenAIRE
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