TY - JOUR
T1 - Accurate Prediction of False ST-Segment Elevation Myocardial Infarction
T2 - Ready for Prime Time?
AU - Heckle, Mark R.
AU - Efeovbokhan, Nephertiti
AU - Thomas, Fridjof
AU - Blumer, Mary
AU - Chumpia, Mason
AU - Ibebuogu, Uzoma
AU - Reed, Guy L.
AU - Khouzam, Rami N.
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/10
Y1 - 2018/10
N2 - The incidence of inappropriate cardiac catheterization lab activation for treatment of a false ST-segment elevation myocardial infarction (STEMI) has been reported to be 2.6%-36%. Excessive inappropriate catheterization lab activation may be associated with risks to patients, provider fatigue and improper resource usage. Hypothesis: To derive and validate a prediction score to more accurately classify patients with STEMI. Methods and results: We conducted a retrospective cohort analysis of 1144 consecutive patients initially diagnosed with STEMI between September 2008 and January 2013. The incidence of catheterization laboratory activation for false STEMI was 21.4%. Multiple logistic regression identified 8 factors as important for prediction of false STEMI. Using a prediction rule derived from these factors, the area under the curve for differentiating false from true STEMI patients was 0.80 (95% CI: 0.75-0.84). Using objective standards, criteria were defined that had 95% specificity for detecting patients with an incorrect diagnosis of STEMI. In conclusion: A prediction rule has been derived and validated in a large, racially diverse group to identify false STEMI patients with an incorrect classification rate of 5%, which is an improvement over current clinical practice. Prediction rules may be particularly useful in patients with atypical presentations in which emergent catheterization cannot be achieved rapidly or carries significant patient risk.
AB - The incidence of inappropriate cardiac catheterization lab activation for treatment of a false ST-segment elevation myocardial infarction (STEMI) has been reported to be 2.6%-36%. Excessive inappropriate catheterization lab activation may be associated with risks to patients, provider fatigue and improper resource usage. Hypothesis: To derive and validate a prediction score to more accurately classify patients with STEMI. Methods and results: We conducted a retrospective cohort analysis of 1144 consecutive patients initially diagnosed with STEMI between September 2008 and January 2013. The incidence of catheterization laboratory activation for false STEMI was 21.4%. Multiple logistic regression identified 8 factors as important for prediction of false STEMI. Using a prediction rule derived from these factors, the area under the curve for differentiating false from true STEMI patients was 0.80 (95% CI: 0.75-0.84). Using objective standards, criteria were defined that had 95% specificity for detecting patients with an incorrect diagnosis of STEMI. In conclusion: A prediction rule has been derived and validated in a large, racially diverse group to identify false STEMI patients with an incorrect classification rate of 5%, which is an improvement over current clinical practice. Prediction rules may be particularly useful in patients with atypical presentations in which emergent catheterization cannot be achieved rapidly or carries significant patient risk.
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U2 - 10.1016/j.cpcardiol.2017.12.003
DO - 10.1016/j.cpcardiol.2017.12.003
M3 - Article
C2 - 29397197
AN - SCOPUS:85041585046
VL - 43
SP - 400
EP - 412
JO - Current Problems in Cardiology
JF - Current Problems in Cardiology
SN - 0146-2806
IS - 10
ER -