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

• Published in: Cardiovascular revascularization medicine 2015-06, Vol.16 (4), p.217-220
• Main Authors: Zhu, Tina, Huitema, Ashlay, Alemayehu, Mistre, Allegretti, Marlene, Chomicki, Connie, Yadegari, Andrew, Lavi, Shahar
• Format: Article
• Language: English
• Subjects: Acute myocardial infarction; Adult; Aged; Aged, 80 and over; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - therapy; Brugada Syndrome; Cardiac Conduction System Disease; Cardiovascular; Case-Control Studies; Coronary Angiography - methods; Electrocardiography; Electrocardiography - methods; Female; Heart Conduction System - abnormalities; Humans; Male; Middle Aged; Myocardial Infarction - diagnosis; Myocardial Infarction - therapy; Primary angioplasty; Treatment Outcome
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2015.04.004

Abstract Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) are occasionally found to have no culprit lesion on coronary angiography and are classified as presenting with false-positive STEMI. The clinical presentation and outcomes of these patients need to be further explored. In this case-controlled study, 259 consecutive patients with true code STEMI were compared to 104 consecutive STEMI patients without culprit lesions on emergent coronary angiography. We compared the clinical presentation, electrocardiographic features, etiology, and outcomes of the two groups. STEMI patients without culprit lesions were less likely to have typical chest pain (46% vs. 79%, P < 0.01). The ST-elevation in the group without culprit lesion was more likely to be concave (56% vs. 31%, P < 0.01), with less reciprocal ST-depression (19% vs. 71%, P < 0.01). The group without culprit lesions had a higher rate of ventilator support requirement (12.4% vs. 5.4%, P = 0.02), and higher rate of 30-day mortality (11.0% vs. 5.9%, P = 0.02). However, after excluding the patients with out-of-hospital cardiac arrests from both groups, the difference was no longer significant (P = 0.40 and 0.34 respectively). The relative poor outcomes of patients with false-positive code STEMI reflect the severity of their underlying medical condition. Careful history and review of ECG may help differentiate this group from true STEMI.