《FalsePositiveSTElevationinPatientsUndergoingDirect》由会员分享，可在线阅读，更多相关《FalsePositiveSTElevationinPatientsUndergoingDirect（19页珍藏版）》请在金锄头文库上搜索。
1、False Positive ST Elevation in Patients Undergoing Direct Percutaneous Coronary InterventionDavid M. Larson MD, Katie M. Menssen, BS, Scott David M. Larson MD, Katie M. Menssen, BS, Scott W Sharkey MD, James Harris MD, Jeffrey T. W Sharkey MD, James Harris MD, Jeffrey T. Meland, MD Robert Schwartz M
2、D, Barbara T Unger Meland, MD Robert Schwartz MD, Barbara T Unger RN, Timothy D. Henry MD,RN, Timothy D. Henry MD,Ridgeview Medical Center, Waconia, Minnesota and Ridgeview Medical Center, Waconia, Minnesota and Minneapolis Heart Institute Foundation, Minneapolis Heart Institute Foundation, Minneapo
3、lis, Minnesota Minneapolis, Minnesota 1 1IntroductionPrevious data shows that up to 11% of STEMI patients treated with thrombolysis did not have a Myocardial Infarction (MI)ACC/AHA guidelines recommend that the Emergency physician make the decision regarding reperfusion therapy for STEMIThere is lim
4、ited data reporting the rate of “false positive” ECGs in STEMI patients treated with Percutaneous Coronary Intervention.2 2Objective1)To determine the incidence and etiologies of “false positive” ECGs, defined as: no culprit coronary vessel and negative cardiac markers (no MI), from a non-selected c
5、ohort of STEMI patients. 2)To determine the incidence of “true false positive” ECGs defined as no culprit, no significant coronary disease and negative cardiac markers.3 3MethodsMinneapolis Heart Institute/Abbott Northwestern Hospital (ANW) a tertiary cardiac center with referral relationships with
6、30 community hospitals (CH) in Minnesota and Wisconsin instituted the “MHI Level 1 MI Program” in 2003. 4 45 5MethodsLevel 1 MI Protocol: Includes STEMI (ST elevation or new Left Bundle Branch Block) with symptom 24hrs. Diagnosis and decision to activate the cath lab is made by the Emergency Physici
7、an at the presenting hospital. Transferred patients go directly to cath lab for Primary or Facilitated PCIData obtained from a prospective registry of all “Level 1 MI” patients that includes clinical, laboratory, ECG, angiographic and follow up data.6 6What is the prevalence and etiology of “False P
8、ositive” Cath Lab Activation?STEMILarson, DM et al JAMA 2007;298(23):2754-27607 7The Clinical Challenge Denying Reperfusion Falsely Declaring an EmergencyLarson, DM et al JAMA 2007;298(23):2754-27608 8Definitions of “False Positive” Cardiac Cath Lab ActivationNo culpritNo significant coronary diseas
9、eNegative cardiac biomarkersLarson, DM et al JAMA 2007;298(23):2754-27609 9Results from the Level 1 MI ProgramFrom 3/03 to 11/06, 1,345 STEMI patients enrolled in Level 1 MI program including 1,048 transferred from 30 rural or community hospitals.149 (11.2%) had normal cardiac biomarker levels.Larso
10、n, DM et al JAMA 2007;298(23):2754-27601010STEMI DiagnosisN=1,345AngiographyN=1,3355 died prior to angio5 Case canceledMultiple potential culpritsN=10 (0.7%)Clear culpritN=1138 (85.3%No Angiographic CulpritN=187 (14%) “ “False Positive” Cath lab ActivationsLarson, DM et al JAMA 20071111No Significan
11、t CADN = 127 (9.5%)Positive Cardiac MarkersN= 48 (38%)Negative Cardiac MarkersN = 44 (73%)No CulpritN=187 (14%)Mod-Severe CADN =60 (4.5%)Positive Cardiac MarkersN= 16 (27%)Negative Cardiac MarkersN = 79 (62%)1212Multiple Potential CulpritsN=10Positive Cardiac MarkersN= 10Negative Cardiac MarkersN =
12、26 Clear culpritN=1138Positive Cardiac MarkersN= 1112 Negative Cardiac MarkersN = 0With a culpritLarson, DM et al JAMA 20071313Positive Cardiac MarkersN= 64 (4.8%)Negative Cardiac MarkersN = 123 (9.2%)No Angiographic CulpritN=187 (14%)Early repolarizationEarly repolarization2525Non-diagnostic ECGNon
13、-diagnostic ECG2121PericarditisPericarditis2020Prior MIPrior MI2020LBBBLBBB1111LVHLVH8 8VasospasmVasospasm4 4Tachycardia relatedTachycardia related3 3RBBBRBBB3 3PacemakerPacemaker3 3Brugada syndromeBrugada syndrome1 1Aortic dissectionAortic dissection1 1UnknownUnknown3 3Stress CardiomyopathyStress C
14、ardiomyopathy1717MyocarditisMyocarditis1515Prior MIPrior MI9 9STEMI embolic/spasmSTEMI embolic/spasm9 9LBBBLBBB4 4NSTEMINSTEMI2 2Pulmonary embolusPulmonary embolus2 2Aortic neoplasmAortic neoplasm1 1Severe aortic stenosisSevere aortic stenosis1 1Drug overdoseDrug overdose1 1UnknownUnknown3 3Larson,
15、DM et al JAMA 20071414No culprit and negative markers by Hospital ED VolumeED visits/yearNot significantLarson, DM et al JAMA 20071515Left Bundle Branch BlockNew or presumed new LBBB observed in 36 (2.6%) of patientsNo culprit: 16 (44%)No significant CAD: 10 (27%)Negative cardiac biomarkers: 13 (36%
16、)30 day mortality in those with new LBBB was 8.3%Larson, DM et al JAMA 2007;298(23):2754-27601616Gender differences381 (28.3%) women enrolled in Level 1 registryNo culprit: 17.1% women vs 12.7% men No culprit: 17.1% women vs 12.7% men (p=0.04)(p=0.04)No significant CAD: 13.6% women vs 7.9% No signif
17、icant CAD: 13.6% women vs 7.9% men (p=0.001)men (p=0.001)Negative biomarkers: 12.3% women vs 10.6% Negative biomarkers: 12.3% women vs 10.6% men (p=0.36)men (p=0.36)Stress cardiomyopathy may account for differencesLarson, DM et al JAMA 2007;298(23):2754-27601717Summary: Incidence of “False Positive”
18、 Cath Lab ActivationNo culprit: 14%Normal or Minimal CAD: 9.5% Negative cardiac markers: 11.2%Combination of no culprit and negative biomarkers: 9.2%Larson, DM et al JAMA 2007;298(23):2754-27601818ConclusionsThe incidence of “false positive” ECGs in STEMI patients treated with Primary PCI is similar to previous data in patients treated with thrombolytic therapy.Patients presenting with “False Positive” ST elevation are a heterogeneous group, many with other serious cardiac conditions.1919
