Incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST-elevation myocardial infarction: Results from the Korea Acute Myocardial Infraction Registry

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Korea Centre for Disease Control and Prevention. Background/Introduction Data regarding the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of ST-elevation myocardial infarction (STEMI) in the modern era of percutaneous coronary intervention are limited. Purpose We investigated the incidence, relevant patient factors, and clinical outcomes of the misdiagnosis of STEMI from a nationwide, prospective Korean registry of acute myocardial infarction. Methods Out of 28,470 patients with acute myocardial infarction between November 2011 and June 2020, 11,796 were eventually diagnosed with STEMI following a coronary angiogram. They were classified into two groups: patients with an initial working diagnosis of STEMI before starting the initial treatment and patients with an initial working diagnosis of non-STEMI (misdiagnosed group). Results Out of 11,796 patients with a final diagnosis of STEMI, 165 (1.4%) were misdiagnosed. The door-to-angiography time in the misdiagnosed group was five times longer than that in the timely diagnosed group (median 220 [interquartile range 66–1177] vs. 43 [31–58] minutes, P <0.001). In a multivariable adjustments model, patients with a history of heart failure, atypical chest pain, anaemia, or symptom-to-door time ≥4 hours had significantly higher odds, whereas those with systolic blood pressure <100 mmHg or anterior ST-elevation or left bundle branch block on electrocardiogram had lower odds of STEMI misdiagnosis (Figure 1). For patients with culprit lesions in the left anterior descending artery (n = 5838), the adjusted one-year mortality risk for STEMI misdiagnosis was 1.84 (95% confidence interval 1.01–3.38; Figure 2). Conclusion Misdiagnosis of STEMI is not uncommon and is associated with a significant delay in coronary angiography, resulting in an increased one-year mortality for patients with culprit lesions in the left anterior descending artery.