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Etiologies and predictors of ST-segment elevation myocardial infarction.
MedLine Citation:
PMID:  23882285     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVES: 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.
SUBJECTS AND METHODS: Four hundred fifty-five consecutive patients (62±13 years, 345 males) with presumptive diagnosis of STEMI between August 2008 and November 2010 were included.
RESULTS: 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.
CONCLUSION: 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.
Authors:
Myung Hwan Bae; Sang Soo Cheon; Joon Hyuk Song; Se Yong Jang; Won Suk Choi; Kyun Hee Kim; Sun Hee Park; Jang Hoon Lee; Dong Heon Yang; Hun Sik Park; Yongkeun Cho; Shung Chull Chae
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Publication Detail:
Type:  Journal Article     Date:  2013-06-30
Journal Detail:
Title:  Korean circulation journal     Volume:  43     ISSN:  1738-5520     ISO Abbreviation:  Korean Circ J     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-07-24     Completed Date:  2013-07-24     Revised Date:  2013-11-18    
Medline Journal Info:
Nlm Unique ID:  101247141     Medline TA:  Korean Circ J     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  370-6     Citation Subset:  -    
Affiliation:
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
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Erratum In:
Korean Circ J. 2013 Aug;43(8):580

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