Author + information
- Christina Dookhan,
- Abhijit Ghatak,
- Alejandro Mantero,
- Eduardo De Marchena,
- Ravi A. Patel,
- Cesar Mendoza and
- Alexandre Ferreira
Background: Timely activation of the Cardiac Catheterization Laboratory in ST Elevation Myocardial Infarction (STEMI) has mortality benefit and is an important core quality metric for primary Percutaneous Coronary Intervention. The focus on time can sometimes trigger unnecessary false activations. We sought to determine trends associated with false STEMI activation at our institution.
Methods: A database of consecutive patients presenting to our institution for possible STEMI from July 2012 to November 2014 was reviewed. False STEMI was defined as an absence of clinical and electrocardiographic evidence of ongoing myocardial infarction. Patients without a visible culprit lesion on coronary angiogram were also included as false STEMI. Multivariate logistic regression analysis of significant associations seen with patients'risk factors, clinical presentation, electrocardiogram and laboratory values was performed and expressed as odds ratio (OR; confidence interval, p value).
Results: Out of the 442 activations (mean age 60.46 ± 2.8 years, 81.7% males), 154 (34.8%) were false. Risk factors for false STEMI activation were heart rate > 100 beats per minute on electrocardiogram (ECG) (OR 3.120; 95% CI 1.520-6.511, p= 0.02) and hyperkalemia (OR 2.490; 95% CI, 1.091-5.815, p= 0.03). On the other hand, presence of Q waves in the anterior (OR 0.062; 95% CI, 0.020-0.164, p<0.001) or inferior (OR 0.3; 95% CI, 0.084-0.896, p=0.042) leads, ST elevation involving the inferior leads (OR 0.121, 95% CI, 0.053-0.257, p<0.001), no prior electrocardiogram (ECG) available (OR 0.073; 95% CI, 0.023-0.199, p<0.001) and presence of new ischemic changes (OR 0.050, 95% CI 0.015-0.144, p<0.001) lowered the odds for false STEMI activation.
Conclusions: Approximately one third of STEMI activations were false STEMIs. Heart rate > 100 beats per minute and hyperkalemia increased the odds for false STEMI activation. ECG findings of Q waves in anterior or inferior leads, ST elevation involving the inferior leads, absence of prior ECG and presence of new ischemic changes reduced the odds for false STEMI activation.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-330
- 2017 American College of Cardiology Foundation