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PPCI for acute STEMI's significantly improves outcomes, but rapid cardiac catheterization laboratory activations result in false-positive activations (FP-STEMI). The long-term mortality of patients with FP-STEMI has not been well-defined.
All patients with acute cardiac laboratory activations for STEMI from 1/1/2008 to 12/31/2013 were included. Patients who received PPCI for a true-positive STEMI and those who had FP-STEMI were compared. FP-STEMI was defined as the lack of a thrombotic total or subtotal coronary artery occlusion on angiography. Baseline characteristics and mortality were acquired via chart review and query of the social security death index.
1549 total patients had acute activations for STEMI; a total of 1140 (73.6%) received PPCI and 234 (15.1%) had FP-STEMI. FP-STEMI patients were younger and less frequently male compared to PPCI patients (Table). At a follow-up of 6.57 ± 1.68 years, there was no difference in cumulative mortality or the temporal distribution of adjusted survival between PPCI and FP-STEMI patients (Figure).
|False-Positive STEMI||Primary PCI||p-values|
|Age||58.4 ± 14.7 y||60.9 ± 12.9 y||0.014|
|Male||60.7% (142)||69.2 % (789)||0.011|
|Mortality (total)||18.8 % (44)||19.2 % (219)||0.885|
|- Mortality (time)||634 ± 713 days||543 ± 716 days||0.442|
|- In-hospital mortality||5.13 % (12)||4.3 % (49)||0.574|
|- 6-month mortality||8.12 % (19)||9.7 % (110)||0.465|
|- 1-year mortality||9.40 % (22)||11.0 % (125)||0.481|
|- Mortality after 1 year||9.40 % (22)||8.3 % (94)||0.562|
|Follow-up||2313 ± 573 days||2418 ± 622 days||0.130|
Patients with FP-STEMI have similar mortality profiles compared to those treated with PPCI for STEMI. Mechanisms of mortality in this group remain poorly defined, but close attention to manifest medical issues and close follow-up is warranted.
CORONARY: Acute Coronary Syndromes