Etiologies and Predictors of ST-Segment Elevation Myocardial Infarction

• Published in: Korean circulation journal Vol. 43; no. 6; pp. 370 - 376
• Main Authors: Bae, Myung Hwan, Cheon, Sang Soo, Song, Joon Hyuk, Jang, Se Yong, Choi, Won Suk, Kim, Kyun Hee, Park, Sun Hee, Lee, Jang Hoon, Yang, Dong Heon, Park, Hun Sik, Cho, Yongkeun, Chae, Shung Chull
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Cardiology 01.06.2013; 대한심장학회
• Subjects: Original; 내과학; Myocardial infarction; False positive reactions
• ISSN: 1738-5520; 1738-5555
• DOI: 10.4070/kcj.2013.43.6.370

Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for the appropriate management of patients. We investigated the prevalence, etiologies and predictors of false-positive diagnosis of STEMI and subsequent inappropriate catheterization laboratory activation in patients with presumptive diagnosis of STEMI. Four hundred fifty-five consecutive patients (62±13 years, 345 males) with presumptive diagnosis of STEMI between August 2008 and November 2010 were included. A false-positive diagnosis of STEMI was made in 34 patients (7.5%) with no indication of coronary artery lesion. Common causes for the false-positive diagnosis were coronary spasm in 10 patients, left ventricular hypertrophy in 5 patients, myocarditis in 4 patients, early repolarization in 3 patients, and previous myocardial infarction and stress-induced cardiomyopathy in 2 patients each. In multivariate logistic regression analysis, symptom-to-door time >12 hours {odds ratio (OR) 4.995, 95% confidence interval (CI) 1.384-18.030, p=0.014}, presenting symptom other than chest pain (OR 7.709, 95% CI 1.255-39.922, p=0.027), absence of Q wave (OR 9.082, CI 2.631-31.351, p<0.001) and absence of reciprocal changes on electrocardiography (ECG) (OR 17.987, CI 5.295-61.106, p<0.001) were independent predictors of false-positive diagnosis of STEMI. In patients whom STEMI was planned for primary coronary intervention, the false-positive diagnosis of STEMI was not rare. Correct interpretation of ECGs and consideration of ST-segment elevation in conditions other than STEMI may reduce inappropriate catheterization laboratory activation.