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      Risk score to predict false-positive ST-segment elevation myocardial infarction in the emergency department: a retrospective analysis

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          Abstract

          Background

          The best treatment approach for ST-segment elevation myocardial infarction (STEMI) is prompt primary percutaneous coronary intervention (PCI). However, some patients show ST elevation on electrocardiography (ECG), but do not have myocardial infarction. We sought to identify the frequency of and to develop a prediction model for false-positive STEMI.

          Methods

          This study was conducted in the emergency departments (EDs) of two hospitals using the same critical pathway (CP) protocol to treat STEMI patients with primary PCI. The prediction model was developed in a derivation cohort and validated in internal and external validation cohorts.

          Results

          Of the CP-activated patients, those for whom ST elevation did not meet the ECG criteria were excluded. Among the patients with appropriate ECG patterns, the incidence of false-positive STEMI in the entire cohort was 16.3%. Independent predictors extracted from the derivation cohort for false-positive STEMI were age < 65 years (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.35–4.89), no chest pain (OR, 12.04; 95% CI, 5.92–25.63), atypical chest pain (OR, 7.40; 95% CI, 3.27–17.14), no reciprocal change (OR, 4.80; 95% CI, 2.54–9.51), and concave-morphology ST elevation (OR, 14.54; 95% CI, 6.87–34.37). Based on the regression coefficients, we established a simplified risk score. In the internal and external validation cohorts, the areas under the receiver operating characteristic curves for our risk score were 0.839 (95% CI, 0.724–0.954) and 0.820 (95% CI, 0.727–0.913), respectively; the positive predictive values were 40.9% and 22.0%, respectively; and the negative predictive values were 94.9% and 96.7%, respectively.

          Discussion

          Our prediction model would help them make rapid decisions with better rationale.

          Conclusion

          We devised a model to predict false-positive STEMI. Larger-scale validation studies are needed to validate our model, and a prospective study to determine whether this model is effective in reducing improper primary PCI in actual clinical practice should be performed.

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          Most cited references 26

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          Index for rating diagnostic tests.

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            2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.

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              Strategies for reducing the door-to-balloon time in acute myocardial infarction.

              Prompt reperfusion treatment is essential for patients who have myocardial infarction with ST-segment elevation. Guidelines recommend that the interval between arrival at the hospital and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, few hospitals meet this objective. We sought to identify hospital strategies that were significantly associated with a faster door-to-balloon time. We surveyed 365 hospitals to determine whether each of 28 specific strategies was in use. We used hierarchical generalized linear models and data on patients from the Centers for Medicare and Medicaid Services to determine the association between hospital strategies and the door-to-balloon time. In multivariate analysis, six strategies were significantly associated with a faster door-to-balloon time. These strategies included having emergency medicine physicians activate the catheterization laboratory (mean reduction in door-to-balloon time, 8.2 minutes), having a single call to a central page operator activate the laboratory (13.8 minutes), having the emergency department activate the catheterization laboratory while the patient is en route to the hospital (15.4 minutes), expecting staff to arrive in the catheterization laboratory within 20 minutes after being paged (vs. >30 minutes) (19.3 minutes), having an attending cardiologist always on site (14.6 minutes), and having staff in the emergency department and the catheterization laboratory use real-time data feedback (8.6 minutes). Despite the effectiveness of these strategies, only a minority of hospitals surveyed were using them. Several specific hospital strategies are associated with a significant reduction in the door-to-balloon time in the management of myocardial infarction with ST-segment elevation. Copyright 2006 Massachusetts Medical Society.
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                Author and article information

                Affiliations
                [1 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Department of Emergency Medicine, , Yonsei University College of Medicine, ; 50 Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
                [2 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Department of Research Affairs, Biostatistics Collaboration Unit, , Yonsei University College of Medicine, ; 50 Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
                [3 ]ISNI 0000 0004 0371 8173, GRID grid.411633.2, Department Emergency Medicine, , Inje University Ilsan Paik Hospital, ; 170 Juhwa-ro, Ilsanseo-gu, 10380 Goyang-si, Gyeonggi-do Republic of Korea
                [4 ]ISNI 0000 0004 0470 5454, GRID grid.15444.30, Division of Cardiology, Department of Internal medicine, , Yonsei University College of Medicine, ; 50 Yonsei-ro, Seodaemun-gu, 03722 Seoul, Republic of Korea
                [5 ]ISNI 0000 0004 0636 3064, GRID grid.415562.1, Department of Emergency Medicine, , Severance Hospital, ; 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
                Contributors
                jichoon81@yush.ac
                YUNHOROH@yuhs.ac
                pys0905@yuhs.ac
                aero7@hanmail.net
                CBY6908@yuhs.ac
                INCHEOL@yuhs.ac
                EMSTAR@yush.ac
                82-2-2228-2460 , boringzzz@yuhs.ac
                Journal
                Scand J Trauma Resusc Emerg Med
                Scand J Trauma Resusc Emerg Med
                Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
                BioMed Central (London )
                1757-7241
                30 June 2017
                30 June 2017
                2017
                : 25
                28666458 5493848 408 10.1186/s13049-017-0408-7
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Original Research
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                © The Author(s) 2017

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