Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention-capable centers: A report from the activate-SF registry

James M. McCabe, Ehrin J. Armstrong, Ameya Kulkarni, Kurt S. Hoffmayer, Prashant D. Bhave, Sonia Garg, Ateet Patel, John S. MacGregor, Priscilla Hsue, John C. Stein, Scott Kinlay, Peter Ganz

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Background: Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations. Methods: We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. "False-positive STEMI activation" was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model. Results: Of 411 STEMI activations by emergency physicians, 146 (36%) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95% CI, 1.55- 6.40; P =.001), a history of coronary disease (AOR, 1.93; 95% CI, 1.04-3.59; P =.04), or prior illicit drug abuse (AOR, 2.67; 95% CI, 1.13-6.26; P =.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a falsepositive activation (AOR, 0.91; 95% CI, 0.86-0.97; P =.004), as did angina at presentation (AOR, 0.28; 95% CI, 0.14-0.57; P < .001). Conclusions: More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of falsepositive STEMI activation.

Original languageEnglish (US)
Pages (from-to)864-871
Number of pages8
JournalArchives of Internal Medicine
Volume172
Issue number11
DOIs
StatePublished - Jun 11 2012

ASJC Scopus subject areas

  • Internal Medicine

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