Nfor Tonga, Kostopoulos Louie, Hashim Hani, Jan M Fuad, Gupta Anjan, Bajwa Tanvir, Allaqaband Suhail
Aurora Cardiovascular Services, Aurora Sinai Medical Center, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA.
J Emerg Med. 2012 Oct;43(4):561-7. doi: 10.1016/j.jemermed.2011.09.027. Epub 2012 Jan 30.
In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) within 90 min of door-to-balloon time, emergency cardiac catheterization laboratory activation protocols bypass routine clinical assessments, raising the possibility of more frequent catheterizations in patients with no culprit coronary lesion.
To determine the incidence, predictors, and prognosis of false-positive STEMI.
We followed a prospective cohort of patients diagnosed with STEMI by usual criteria receiving emergency cardiac catheterization with intention of primary PCI between January 2005 and December 2007 at a tertiary care center. False-positive STEMI was defined as absence of a clear culprit lesion on coronary angiography.
Of 489 patients who received emergency cardiac catheterization indicated for STEMI, 54 (11.0%, 95% confidence interval [CI] 8.3-13.8) had no culprit lesion on coronary angiography. Independent predictors of false-positive STEMI were absence of chest pain (odds ratio [OR] 18.2, 95% CI 3.7-90.1), no reciprocal ST-segment changes (OR 11.8, 95% CI 5.14-27.3), fewer than three cardiovascular risk factors (OR 9.79, 95% CI 4.0-23.8), and symptom duration longer than 6h (OR 9.2, 95% CI 3.6-23.7); all p<0.001. Using predictors, we modeled a risk score that achieved 88% (95% CI 81-94%) accuracy in identifying patients with negative coronary angiography. Among the false-positive STEMI patients, 48.1% had other serious diagnoses related to their electrocardiographic findings.
When the diagnosis of STEMI is in doubt, clinicians may use predictors to quickly reassess the likelihood of an alternative diagnosis.
为了推动在门球时间90分钟内对ST段抬高型心肌梗死（STEMI）患者进行直接经皮冠状动脉介入治疗（PCI），急诊心脏导管实验室激活方案绕过了常规临床评估，增加了对无罪犯冠状动脉病变患者进行更频繁导管插入术的可能性。
确定假阳性STEMI的发生率、预测因素和预后。
我们对2005年1月至2007年12月在一家三级医疗中心按照常规标准诊断为STEMI并接受急诊心脏导管插入术以进行直接PCI的患者进行了前瞻性队列研究。假阳性STEMI定义为冠状动脉造影未发现明确的罪犯病变。
在489例因STEMI接受急诊心脏导管插入术的患者中，54例（11.0%，95%置信区间[CI]8.3-13.8）冠状动脉造影无罪犯病变。假阳性STEMI的独立预测因素包括无胸痛（比值比[OR]18.2，95%CI 3.7-90.1）、无ST段对应性改变（OR 11.8，95%CI 5.14-27.3）、心血管危险因素少于三个（OR 9.79，95%CI 4.0-23.8）以及症状持续时间超过6小时（OR 9.2，95%CI 3.6-23.7）；所有p<0.001。使用这些预测因素，我们建立了一个风险评分模型，在识别冠状动脉造影阴性的患者方面，其准确率达到88%（95%CI 81-94%）。在假阳性STEMI患者中，48.1%有与心电图表现相关的其他严重诊断。
当对STEMI的诊断存在疑问时，临床医生可使用预测因素快速重新评估其他诊断的可能性。
