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

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

Am J Emerg Med. 2013 May;31(5):825-9

Authors: Chung SL, Lei MH, Chen CC, Hsu YC, Yang CC

Abstract
BACKGROUND: There are several causes of ST-segment elevation (STE) besides acute myocardial infarction (MI).
OBJECTIVES: We design this study to determine the prevalence, etiology, clinical manifestation, electrocardiographic characteristics, and outcome in patients with false-positive STEMI.
METHODS: This is a retrospective case-control study design. At our emergency department, 297 patients who underwent emergent coronary angiography for suspected STEMI were enrolled from January 2004 to December 2010.
RESULTS: Of the 297 patients who underwent coronary angiography, 31 patients (10.4%) did not have a clear culprit coronary lesion and were classified as false-positive STEMI. False-positive STEMI patients had a lower incidence of typical chest pain or chest tightness (58.1% vs 87.6%, P < .001). Inferior STE occurred significantly more often in the patients with true-positive STEMI (49.6% vs 25.8%, P = .012), and diffuse STE, more often in the patients with false-positive STEMI (19.4% vs 0.38%, P = .001). Total height of STE was lower in false-positive STEMI patients (7.5 ± 4.9 vs 10.9 ± 7.9 mm, P = .002) if excluding 5 patients of marked STE just after cardiopulmonary resuscitation. Concave STE and no reciprocal ST-segment depression occurred more often in false-positive STEMI patients (51.6% vs 24.1%, P = .001; 64.5% vs 19.2%, P < .001). There was no significant difference of in-hospital major adverse events in the patients with false-positive and true-positive STEMI.
CONCLUSIONS: The diagnosis of false-positive STEMI is not uncommon. Detailed clinical evaluation and electrocardiogram interpretation may avoid partly unnecessary catheterization laboratory activation.

PMID: 23478112 [PubMed - indexed for MEDLINE]

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