Characteristics of patients with false- ST-segment elevation myocardial infarction diagnoses

• Published in: European heart journal. Acute cardiovascular care 2016-08, Vol.5 (4), p.339-346
• Main Authors: Groot, Hilde E, Wieringa, Wouter G, Mahmoud, Karim D, Lexis, Chris PH, Hiemstra, Bart, van der Harst, Pim, Lipsic, Erik
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Aged; Coronary Angiography; Diagnostic Errors - statistics & numerical data; Female; Humans; Male; Middle Aged; Multivariate Analysis; Risk Factors; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - pathology
• ISSN: 2048-8726; 2048-8734
• DOI: 10.1177/2048872615581500

Background: A subgroup of patients presenting with suspected ST-elevation myocardial infarction (STEMI) have no culprit lesion during coronary angiography (false-positive STEMI). Little is known about patient- and system-related factors that are associated with false-positive STEMI. We evaluated the incidence, correlates, delay, final diagnosis, and outcome of patients with false-positive STEMI. Methods: We studied 827 consecutive patients presenting with suspected STEMI between January 2011–September 2012. Results: A false positive STEMI activation was identified in 68 patients (8.2%). Patients with false-positive STEMI were younger (57 vs 63 year; p=0.020), less often had hypercholesterolemia (19 vs 43%; p=0.001), and had a higher heart rate (82 vs 75 bpm; p=0.014). The association between these factors and false-positive STEMI activation persisted in multivariate analysis. The duration of symptoms to call was longer in false-positive STEMI patients (128 vs 83 min; p=0.030), although this did not reach statistical significance in multivariate analysis. Final diagnosis in patients with false-positive STEMI activation was particularly from unknown origin (41%). There were no significant differences in mortality at 30 days and one year between patients with STEMI and false-positive STEMI. Conclusion: The incidence of false-positive STEMI was 8.2% in patients suspected of STEMI. Patients with false-positive STEMI differ from STEMI patients in certain baseline characteristics and in patient delay. Interestingly, absence of coronary disease did not translate into better clinical outcome.