Abstract 1756: False Positive ST Elevation in Patients Undergoing Direct Percutaneous Coronary Intervention
Background: Data from the thrombolytic era report up to 11% of treated STEMI patients did not have a MI. There is limited data reporting the rate of “false positive” ECGs in STEMI patients treated with PCI.
Methods: We determined the incidence and etiology of “false positive” ECGs in 958 consecutive STEMI patients, including 746 patients transferred for direct PCI from 28 rural and community hospitals (range 20–160 bed hospitals) to Abbott Northwestern Hospital as part of the Level 1 MI program. This protocol allows the emergency physician to interpret the ECG and to activate the cath lab team directly.
Results: Thirteen percent (n = 124) did not have a clear culprit vessel, although 26% of these had an MI. (table⇓) One year mortality with culprit was 7.2% vs 4.8% without. (p = 0.45) Overall 8.6% of patients had minimal or no coronary disease and of this group 28% had an MI. True “false positive” ECG defined as: no culprit, no significant CAD and no MI was 6.2%.
Conclusion: Patients presenting with “false positive” ST elevation are a heterogeneous group, many with serious cardiac conditions. Only 6.2% have true “false positive” ECG. Emergency physicians from various hospitals make appropriate diagnostic decisions and activate the cath lab without excessive false positive diagnosis of STEMI.