Groot Hilde E, Wieringa Wouter G, Mahmoud Karim D, Lexis Chris Ph, Hiemstra Bart, van der Harst Pim, Lipsic Erik
Department of Cardiology, University of Groningen, The Netherlands.
Department of Cardiology, University of Groningen, The Netherlands
Eur Heart J Acute Cardiovasc Care. 2016 Aug;5(4):339-46. doi: 10.1177/2048872615581500. Epub 2015 Apr 14.
A subgroup of patients presenting with suspected ST-elevation myocardial infarction (STEMI) have no culprit lesion during coronary angiography (false-positive STEMI). Little is known about patient- and system-related factors that are associated with false-positive STEMI. We evaluated the incidence, correlates, delay, final diagnosis, and outcome of patients with false-positive STEMI.
We studied 827 consecutive patients presenting with suspected STEMI between January 2011-September 2012.
A false positive STEMI activation was identified in 68 patients (8.2%). Patients with false-positive STEMI were younger (57 vs 63 year; p=0.020), less often had hypercholesterolemia (19 vs 43%; p=0.001), and had a higher heart rate (82 vs 75 bpm; p=0.014). The association between these factors and false-positive STEMI activation persisted in multivariate analysis. The duration of symptoms to call was longer in false-positive STEMI patients (128 vs 83 min; p=0.030), although this did not reach statistical significance in multivariate analysis. Final diagnosis in patients with false-positive STEMI activation was particularly from unknown origin (41%). There were no significant differences in mortality at 30 days and one year between patients with STEMI and false-positive STEMI.
The incidence of false-positive STEMI was 8.2% in patients suspected of STEMI. Patients with false-positive STEMI differ from STEMI patients in certain baseline characteristics and in patient delay. Interestingly, absence of coronary disease did not translate into better clinical outcome.
一部分表现为疑似ST段抬高型心肌梗死（STEMI）的患者在冠状动脉造影时没有罪犯病变（假阳性STEMI）。关于与假阳性STEMI相关的患者及系统因素知之甚少。我们评估了假阳性STEMI患者的发生率、相关因素、延迟情况、最终诊断及预后。
我们研究了2011年1月至2012年9月期间连续就诊的827例疑似STEMI患者。
68例患者（8.2%）被确定为假阳性STEMI激活。假阳性STEMI患者更年轻（57岁对63岁；p=0.020），高胆固醇血症的发生率更低（19%对43%；p=0.001），心率更高（82次/分对75次/分；p=0.014）。在多变量分析中，这些因素与假阳性STEMI激活之间的关联仍然存在。假阳性STEMI患者从症状出现到呼叫的时间更长（128分钟对83分钟；p=0.030），尽管在多变量分析中这未达到统计学意义。假阳性STEMI激活患者的最终诊断尤其多为病因不明（41%）。STEMI患者与假阳性STEMI患者在30天和1年时的死亡率没有显著差异。
疑似STEMI患者中假阳性STEMI的发生率为8.2%。假阳性STEMI患者在某些基线特征和患者延迟方面与STEMI患者不同。有趣的是，无冠状动脉疾病并未转化为更好的临床结局。
