Korean Circulation Journal

  • 제43권6호
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  • Pages.370-376
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  • 2013
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  • 1738-5520(pISSN)
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  • 1738-5555(eISSN)
대한심장학회 (The Korean Society of Cardiology)
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Etiologies and Predictors of ST-Segment Elevation Myocardial Infarction

  • Bae, Myung Hwan (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Cheon, Sang Soo (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Song, Joon Hyuk (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Jang, Se Yong (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Choi, Won Suk (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Kim, Kyun Hee (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Park, Sun Hee (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Lee, Jang Hoon (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Yang, Dong Heon (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Park, Hun Sik (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Cho, Yongkeun (Department of Internal Medicine, Kyungpook National University Hospital) ;
  • Chae, Shung Chull (Department of Internal Medicine, Kyungpook National University Hospital)
  • 발행 : 2013.06.30
⟨ 이전 논문 다음 논문 ⟩

초록

Background and Objectives: Rapid diagnosis of ST-segment elevation myocardial infarction (STEMI) is essential for the appropriate management of patients. We investigated the prevalence, etiologies and predictors of false-positive diagnosis of STEMI and subsequent inappropriate catheterization laboratory activation in patients with presumptive diagnosis of STEMI. Subjects and Methods: Four hundred fifty-five consecutive patients ($62{\pm}13$ years, 345 males) with presumptive diagnosis of STEMI between August 2008 and November 2010 were included. Results: A false-positive diagnosis of STEMI was made in 34 patients (7.5%) with no indication of coronary artery lesion. Common causes for the false-positive diagnosis were coronary spasm in 10 patients, left ventricular hypertrophy in 5 patients, myocarditis in 4 patients, early repolarization in 3 patients, and previous myocardial infarction and stress-induced cardiomyopathy in 2 patients each. In multivariate logistic regression analysis, symptom-to-door time >12 hours {odds ratio (OR) 4.995, 95% confidence interval (CI) 1.384-18.030, p=0.014}, presenting symptom other than chest pain (OR 7.709, 95% CI 1.255-39.922, p=0.027), absence of Q wave (OR 9.082, CI 2.631-31.351, p<0.001) and absence of reciprocal changes on electrocardiography (ECG) (OR 17.987, CI 5.295-61.106, p<0.001) were independent predictors of false-positive diagnosis of STEMI. Conclusion: In patients whom STEMI was planned for primary coronary intervention, the false-positive diagnosis of STEMI was not rare. Correct interpretation of ECGs and consideration of ST-segment elevation in conditions other than STEMI may reduce inappropriate catheterization laboratory activation.

키워드

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