Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention-capable centers: A report from the activate-SF registry

James M. McCabe, Ehrin J. Armstrong, Ameya Kulkarni, Kurt S. Hoffmayer, Prashant D. Bhave, Sonia Garg, Ateet Patel, John S. MacGregor, Priscilla Hsue, John C. Stein, Scott Kinlay, Peter Ganz

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Abstract

Background: Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations. Methods: We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. "False-positive STEMI activation" was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model. Results: Of 411 STEMI activations by emergency physicians, 146 (36%) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95% CI, 1.55- 6.40; P =.001), a history of coronary disease (AOR, 1.93; 95% CI, 1.04-3.59; P =.04), or prior illicit drug abuse (AOR, 2.67; 95% CI, 1.13-6.26; P =.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a falsepositive activation (AOR, 0.91; 95% CI, 0.86-0.97; P =.004), as did angina at presentation (AOR, 0.28; 95% CI, 0.14-0.57; P < .001). Conclusions: More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of falsepositive STEMI activation.

Original languageEnglish (US)
Pages (from-to)864-871
Number of pages8
JournalArchives of Internal Medicine
Volume172
Issue number11
DOIs
StatePublished - Jun 11 2012

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Percutaneous Coronary Intervention
Registries
Myocardial Infarction
Odds Ratio
Angiography
Logistic Models
Street Drugs
Left Ventricular Hypertrophy
Cardiac Catheterization
Reperfusion
Substance-Related Disorders
Coronary Disease
ST Elevation Myocardial Infarction
Hospital Emergency Service
Heart Diseases
Body Mass Index
Emergencies
Heart Failure
Biomarkers
Physicians

ASJC Scopus subject areas

  • Internal Medicine

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Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention-capable centers : A report from the activate-SF registry. / McCabe, James M.; Armstrong, Ehrin J.; Kulkarni, Ameya; Hoffmayer, Kurt S.; Bhave, Prashant D.; Garg, Sonia; Patel, Ateet; MacGregor, John S.; Hsue, Priscilla; Stein, John C.; Kinlay, Scott; Ganz, Peter.

In: Archives of Internal Medicine, Vol. 172, No. 11, 11.06.2012, p. 864-871.

Research output: Contribution to journalArticle

McCabe, James M. ; Armstrong, Ehrin J. ; Kulkarni, Ameya ; Hoffmayer, Kurt S. ; Bhave, Prashant D. ; Garg, Sonia ; Patel, Ateet ; MacGregor, John S. ; Hsue, Priscilla ; Stein, John C. ; Kinlay, Scott ; Ganz, Peter. / Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention-capable centers : A report from the activate-SF registry. In: Archives of Internal Medicine. 2012 ; Vol. 172, No. 11. pp. 864-871.
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abstract = "Background: Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations. Methods: We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. {"}False-positive STEMI activation{"} was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model. Results: Of 411 STEMI activations by emergency physicians, 146 (36{\%}) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95{\%} CI, 1.55- 6.40; P =.001), a history of coronary disease (AOR, 1.93; 95{\%} CI, 1.04-3.59; P =.04), or prior illicit drug abuse (AOR, 2.67; 95{\%} CI, 1.13-6.26; P =.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a falsepositive activation (AOR, 0.91; 95{\%} CI, 0.86-0.97; P =.004), as did angina at presentation (AOR, 0.28; 95{\%} CI, 0.14-0.57; P < .001). Conclusions: More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of falsepositive STEMI activation.",
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AU - Armstrong, Ehrin J.

AU - Kulkarni, Ameya

AU - Hoffmayer, Kurt S.

AU - Bhave, Prashant D.

AU - Garg, Sonia

AU - Patel, Ateet

AU - MacGregor, John S.

AU - Hsue, Priscilla

AU - Stein, John C.

AU - Kinlay, Scott

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N2 - Background: Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations. Methods: We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. "False-positive STEMI activation" was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model. Results: Of 411 STEMI activations by emergency physicians, 146 (36%) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95% CI, 1.55- 6.40; P =.001), a history of coronary disease (AOR, 1.93; 95% CI, 1.04-3.59; P =.04), or prior illicit drug abuse (AOR, 2.67; 95% CI, 1.13-6.26; P =.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a falsepositive activation (AOR, 0.91; 95% CI, 0.86-0.97; P =.004), as did angina at presentation (AOR, 0.28; 95% CI, 0.14-0.57; P < .001). Conclusions: More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of falsepositive STEMI activation.

AB - Background: Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations. Methods: We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. "False-positive STEMI activation" was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model. Results: Of 411 STEMI activations by emergency physicians, 146 (36%) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95% CI, 1.55- 6.40; P =.001), a history of coronary disease (AOR, 1.93; 95% CI, 1.04-3.59; P =.04), or prior illicit drug abuse (AOR, 2.67; 95% CI, 1.13-6.26; P =.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a falsepositive activation (AOR, 0.91; 95% CI, 0.86-0.97; P =.004), as did angina at presentation (AOR, 0.28; 95% CI, 0.14-0.57; P < .001). Conclusions: More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of falsepositive STEMI activation.

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