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CLINICAL PRESENTATION AND OUTCOME OF PATIENTS WITH FALSE-POSITIVE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION
Abstracts
no statistical difference between STd(-)aVR(+) and STd(-) aVR(-) groups in the rate of TIMI flow grade of 0-2, inhospital percutaneous coronary intervention and in-hospital MACE. With the use of multivariate analysis in all studied population, ST depression was strongly associated with multivessel disease (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.05 to 3.48; p¼0.034). However, ST elevation in lead aVR lost its statistical significance (OR 1.84; 95% CI 0.93 to 3.70; p¼0.082). CONCLUSION: In NSTEMI patients without ST depression, ST elevation in lead aVR has a predictive value for multivessel disease and in-hospital CABG. However, ST depression carries a stronger predictive value for multi-vessel disease and ST elevation in lead aVR lost its statistical significance in the presence of coexisting ST depression.
S61 CONCLUSION:
Patients with false-positive code STEMI may have relatively poor outcome due to other medical conditions. Careful history and review of ECG may help differentiate this group from true STEMI. Out-of-hospital activation of code STEMIs significantly reduces first medical contact-to-balloon time compared to in-hospital activations.
013 CLINICAL PRESENTATION AND OUTCOME OF PATIENTS WITH FALSE-POSITIVE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION TR Zhu, A Huitema, M Alemayehu, M Allegretti, C Chomicki, A Yadegari, S Lavi London, Ontario BACKGROUND:
Activation of the cardiac catheterization laboratories through regional code STEMI programs by paramedics shortens time to reperfusion, but may increase the rate of false-positive STEMI. METHODS: In this retrospective, case-control study, 259 consecutive patients with true code STEMI were compared to 81 consecutive patients with false-positive code STEMI activation. The clinical presentation, electrocardiographic features, etiology, and outcomes were assessed. We also compared the effectiveness of out of hospital and in-hospital activation of code STEMIs. RESULTS: Patients with false-positive STEMI were less likely to have typical chest pain (43% vs. 79%, P<0.01). The ST elevations in the false-positive STEMI group were more likely to be concave (60% vs. 31%, P<0.01), with less reciprocal ST-depression (16% vs. 70%, P<0.01). The false-positive STEMI group had higher rate of ventilator support requirement (12.3% vs. 5.4%, P¼0.03), but 30-day mortality was not statistically different between the two groups (9.9% vs. 5.8%, P¼0.12). Although the final diagnosis in over 70% of false-positive STEMIs was relatively benign and included myocarditis /pericarditis, Takatsubo’s cardiomyopathy, vasospasm, early repolarization, or residual changes from previous infarcts, ominous diagnosis such as aortic stenosis, post-arrest, cardiogenic shock, and pulmonary embolus contributed to the high mortality rate. In the true STEMI group, out-of-hospital activation reduced the first medical contact-to-balloon time by an average of 51 minutes, and 60% of the out-of-hospital activations achieved the 90 minutes first medical contact-toballoon target compared to only 23% of the in-hospital activations.
014 ELECTROCARDIOGRAPHIC DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN PACED RHYTHMS: UTILITY OF THE SGARBOSSA CRITERIA CB Fordyce, S Alipour, A Pu, MT Bennett Vancouver, British Columbia BACKGROUND:
Right ventricular pacing can mask the ECG changes associated with acute coronary syndrome (ACS) which can result in suboptimal medical therapy and delay in reperfusion compared to non-paced individuals. The Sgarbossa Criteria (SC) are a validated set of three highly-specific ECG criteria commonly used to diagnosis acute myocardial infarction in non-paced patients with pre-existing left bundle branch block. The aim of this study was to determine the utility of the SC to diagnose acute myocardial infarction as determined by features on coronary anatomy in the setting of a paced rhythm. METHODS: All patients known to have pacemakers who received a cardiac catheterization for the indication of ACS from May 1999 to January 2012 at either Saint Paul’s Hospital or Vancouver General Hospital were reviewed. Patients who had at least one available 12-lead ECG with ventricular
no statistical difference between STd(-)aVR(+) and STd(-) aVR(-) groups in the rate of TIMI flow grade of 0-2, inhospital percutaneous coronary intervention and in-hospital MACE. With the use of multivariate analysis in all studied population, ST depression was strongly associated with multivessel disease (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.05 to 3.48; p¼0.034). However, ST elevation in lead aVR lost its statistical significance (OR 1.84; 95% CI 0.93 to 3.70; p¼0.082). CONCLUSION: In NSTEMI patients without ST depression, ST elevation in lead aVR has a predictive value for multivessel disease and in-hospital CABG. However, ST depression carries a stronger predictive value for multi-vessel disease and ST elevation in lead aVR lost its statistical significance in the presence of coexisting ST depression.
S61 CONCLUSION:
Patients with false-positive code STEMI may have relatively poor outcome due to other medical conditions. Careful history and review of ECG may help differentiate this group from true STEMI. Out-of-hospital activation of code STEMIs significantly reduces first medical contact-to-balloon time compared to in-hospital activations.
013 CLINICAL PRESENTATION AND OUTCOME OF PATIENTS WITH FALSE-POSITIVE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION TR Zhu, A Huitema, M Alemayehu, M Allegretti, C Chomicki, A Yadegari, S Lavi London, Ontario BACKGROUND:
Activation of the cardiac catheterization laboratories through regional code STEMI programs by paramedics shortens time to reperfusion, but may increase the rate of false-positive STEMI. METHODS: In this retrospective, case-control study, 259 consecutive patients with true code STEMI were compared to 81 consecutive patients with false-positive code STEMI activation. The clinical presentation, electrocardiographic features, etiology, and outcomes were assessed. We also compared the effectiveness of out of hospital and in-hospital activation of code STEMIs. RESULTS: Patients with false-positive STEMI were less likely to have typical chest pain (43% vs. 79%, P<0.01). The ST elevations in the false-positive STEMI group were more likely to be concave (60% vs. 31%, P<0.01), with less reciprocal ST-depression (16% vs. 70%, P<0.01). The false-positive STEMI group had higher rate of ventilator support requirement (12.3% vs. 5.4%, P¼0.03), but 30-day mortality was not statistically different between the two groups (9.9% vs. 5.8%, P¼0.12). Although the final diagnosis in over 70% of false-positive STEMIs was relatively benign and included myocarditis /pericarditis, Takatsubo’s cardiomyopathy, vasospasm, early repolarization, or residual changes from previous infarcts, ominous diagnosis such as aortic stenosis, post-arrest, cardiogenic shock, and pulmonary embolus contributed to the high mortality rate. In the true STEMI group, out-of-hospital activation reduced the first medical contact-to-balloon time by an average of 51 minutes, and 60% of the out-of-hospital activations achieved the 90 minutes first medical contact-toballoon target compared to only 23% of the in-hospital activations.
014 ELECTROCARDIOGRAPHIC DIAGNOSIS OF ACUTE MYOCARDIAL INFARCTION IN PACED RHYTHMS: UTILITY OF THE SGARBOSSA CRITERIA CB Fordyce, S Alipour, A Pu, MT Bennett Vancouver, British Columbia BACKGROUND:
Right ventricular pacing can mask the ECG changes associated with acute coronary syndrome (ACS) which can result in suboptimal medical therapy and delay in reperfusion compared to non-paced individuals. The Sgarbossa Criteria (SC) are a validated set of three highly-specific ECG criteria commonly used to diagnosis acute myocardial infarction in non-paced patients with pre-existing left bundle branch block. The aim of this study was to determine the utility of the SC to diagnose acute myocardial infarction as determined by features on coronary anatomy in the setting of a paced rhythm. METHODS: All patients known to have pacemakers who received a cardiac catheterization for the indication of ACS from May 1999 to January 2012 at either Saint Paul’s Hospital or Vancouver General Hospital were reviewed. Patients who had at least one available 12-lead ECG with ventricular