Document Detail


Differentiating ST-Elevation Myocardial Infarction from Nonischemic ST-Elevation in Patients With Chest Pain.
MedLine Citation:
PMID:  21791329     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Current guidelines state that patients with compatible symptoms and ST-segment elevation (STE) in ≥2 contiguous electrocardiographic leads should undergo immediate reperfusion therapy. Aggressive attempts at decreasing door-to-balloon times have led to more frequent activation of primary percutaneous coronary intervention (pPCI) protocols. However, it remains crucial to correctly differentiate STE myocardial infarction (STEMI) from nonischemic STE (NISTE). We assessed the ability of experienced interventional cardiologists in determining whether STE represents acute STEMI or NISTE. Seven readers studied electrocardiograms of consecutive patients showing STE. Patients with left bundle branch block or ventricular rhythms were excluded. Readers decided if, based on electrocardiographic results, they would have activated the pPCI protocol. If NISTE was chosen, readers selected from 12 possible explanations as to why STE was present. Of 84 patients, 40 (48%) had adjudicated STEMI. The percentage for which readers recommended pPCI varied (33% to 75%). Readers' sensitivity and specificity ranged from 55% to 83% (average 71%) and 32% to 86% (average 63%), respectively. Positive and negative predictive values ranged from 52% to 79% (average 66%) and 67% to 79% (average 71%), respectively. Broad inconsistencies existed among readers as to the chosen reasons for NISTE classification. In conclusion, we found wide variations in experienced interventional cardiologists in differentiating STEMI with a need for pPCI from NISTE.
Authors:
Viet Tran; Henry D Huang; Jose G Diez; Gerardo Kalife; Rajiv Goswami; David Paniagua; Hani Jneid; James M Wilson; Scott R Sherron; Yochai Birnbaum
Related Documents :
21734559 - A blood assist index control by intraaorta pump: a control strategy for ventricular rec...
22616639 - Late left ventricular perforation by active fixation pacemaker lead implanted in the ri...
22421549 - Ischemic postconditioning through percutaneous transluminal coronary angioplasty in pig...
9134619 - The heart muscle's putative "secondary structure'. functional implications of a band-li...
21846639 - Pacing the right ventricular outflow tract septum: time to embrace the future.
19757029 - Architecture of the left ventricle: insights for optimal surgical ventricular restoration.
22819469 - The effect of isoflurane on survival and myocardial infarction: a meta-analysis of rand...
18420649 - Temporary pacing wire in the coronary sinus: a novel treatment of acute heart failure?
17675179 - Chronobiology and chronotherapy of ischemic heart disease.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-24
Journal Detail:
Title:  The American journal of cardiology     Volume:  -     ISSN:  1879-1913     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Twenty-five year experience with balloon aortic valvuloplasty for congenital aortic stenosis.
Next Document:  Relation of Plasma Levels of Adiponectin to Left Ventricular Diastolic Dysfunction in Patients Under...