Zhu Tina, Huitema Ashlay, Alemayehu Mistre, Allegretti Marlene, Chomicki Connie, Yadegari Andrew, Lavi Shahar
Western University, Canada; London Health Sciences Centre, Canada.
London Health Sciences Centre, Canada.
Cardiovasc Revasc Med. 2015 Jun;16(4):217-20. doi: 10.1016/j.carrev.2015.04.004. Epub 2015 Apr 20.
Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) are occasionally found to have no culprit lesion on coronary angiography and are classified as presenting with false-positive STEMI. The clinical presentation and outcomes of these patients need to be further explored. In this case-controlled study, 259 consecutive patients with true code STEMI were compared to 104 consecutive STEMI patients without culprit lesions on emergent coronary angiography. We compared the clinical presentation, electrocardiographic features, etiology, and outcomes of the two groups. STEMI patients without culprit lesions were less likely to have typical chest pain (46% vs. 79%, P < 0.01). The ST-elevation in the group without culprit lesion was more likely to be concave (56% vs. 31%, P < 0.01), with less reciprocal ST-depression (19% vs. 71%, P < 0.01). The group without culprit lesions had a higher rate of ventilator support requirement (12.4% vs. 5.4%, P = 0.02), and higher rate of 30-day mortality (11.0% vs. 5.9%, P = 0.02). However, after excluding the patients with out-of-hospital cardiac arrests from both groups, the difference was no longer significant (P = 0.40 and 0.34 respectively). The relative poor outcomes of patients with false-positive code STEMI reflect the severity of their underlying medical condition. Careful history and review of ECG may help differentiate this group from true STEMI.
被诊断为ST段抬高型心肌梗死（STEMI）的患者在冠状动脉造影时偶尔会发现没有罪犯病变，这类患者被归类为假性STEMI。这些患者的临床表现和预后需要进一步探究。在这项病例对照研究中，将259例连续的真性编码STEMI患者与104例在急诊冠状动脉造影时无罪犯病变的连续STEMI患者进行了比较。我们比较了两组患者的临床表现、心电图特征、病因及预后。无罪犯病变的STEMI患者出现典型胸痛的可能性较小（46%对79%，P<0.01）。无罪犯病变组的ST段抬高更可能呈凹形（56%对31%，P<0.01），伴有较少的ST段压低（19%对71%，P<0.01）。无罪犯病变组需要呼吸机支持的比例较高（12.4%对5.4%，P=0.02），30天死亡率也较高（11.0%对5.9%，P=0.02）。然而，在排除两组中发生院外心脏骤停的患者后，差异不再显著（分别为P=0.40和0.34）。假性编码STEMI患者相对较差的预后反映了其潜在疾病的严重程度。仔细询问病史和复查心电图可能有助于将该组患者与真性STEMI区分开来。
