title: Prevalence and factors associated with false-positive ST-segment elevation myocardial infarction diagnoses at primary percutaneous coronary intervention–capable centers: a report from the Activate-SF registry.
abstract: BACKGROUND
  Rapid activation of the cardiac catheterization laboratory for primary percutaneous coronary intervention (PCI) improves outcomes for ST-segment elevation myocardial infarction (STEMI), but selected emphasis on minimizing time to reperfusion may lead to a greater frequency of false-positive activations.
  
  
  METHODS
  We analyzed consecutive patients referred for primary PCI for a possible STEMI at 2 centers from October 2008 to April 2011. "False-positive STEMI activation" was defined as lack of a culprit lesion by angiography or by assessment of clinical, electrocardiographic, and biomarker data in the absence of angiography. Clinical and electrocardiographic factors associated with false-positive activations were evaluated in a backward stepwise selection bootstrapped logistic regression model.
  
  
  RESULTS
  Of 411 STEMI activations by emergency physicians, 146 (36%) were deemed to be false-positive activations. Structural heart disease and heart failure were the most common diagnoses among false-positive activations. Electrocardiographic left ventricular hypertrophy (adjusted odds ratio [AOR], 3.15; 95% CI, 1.55-6.40; P=.001), a history of coronary disease (AOR, 1.93; 95% CI, 1.04-3.59; P=.04), or prior illicit drug abuse (AOR, 2.67; 95% CI, 1.13-6.26; P=.02) independently increased the odds of false-positive STEMI activations. Increasing body mass index decreased the odds of a false-positive activation (AOR, 0.91; 95% CI, 0.86-0.97; P=.004), as did angina at presentation (AOR, 0.28; 95% CI, 0.14-0.57; P < .001).
  
  
  CONCLUSIONS
  More than a third of patients referred for primary PCI from the emergency department did not have a STEMI. Multiple patient-level characteristics were significantly associated with an increased odds of false-positive STEMI activation.
authors.affiliation: Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mccabe@aya.yale.edu
authors.forename: James M
authors.initials: JM
authors.lastname: McCabe
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.forename: Ameya
authors.initials: A
authors.lastname: Kulkarni
authors.forename: Kurt S
authors.initials: KS
authors.lastname: Hoffmayer
authors.forename: Prashant D
authors.initials: PD
authors.lastname: Bhave
authors.forename: Sonia
authors.initials: S
authors.lastname: Garg
authors.forename: Ateet
authors.initials: A
authors.lastname: Patel
authors.forename: John S
authors.initials: JS
authors.lastname: MacGregor
authors.forename: Priscilla
authors.initials: P
authors.lastname: Hsue
authors.forename: John C
authors.initials: JC
authors.lastname: Stein
authors.forename: Scott
authors.initials: S
authors.lastname: Kinlay
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D004638:Emergency Treatment / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D019210:Troponin I