CRT-100.49 Diaphoresis, but Not Dyspnea, Nausea, or Dizziness, Is Associated With Finding a Culprit Lesion in Patients With Suspected ST Elevation Infarction
Document Type
Article
Abstract
Background: False positive (FP) invasive laboratory activation for suspected ST elevation infarction (STEMI), with no culprit lesion (Cul) found, remains common. Non-chest pain (NCP) symptoms (sx), including dyspnea (Dysp), nausea/vomiting (N/V), diaphoresis (Diaph), or dizziness/syncope (Diz/Syn) are regarded as supporting the diagnosis of STEMI, but this assumption has never been tested against angiography. We reviewed patients with ST elevation (STE) who had urgent catheterization (cath) and assessed whether NCP sx increased the likelihood that a Cul was present.
Methods: 1,394 consecutive patients undergoing urgent cath for suspected STEMI at an 11 hospital network, with ≥1mm STE in ≥2 leads. Records were reviewed for NCP sx and for the presence (Cul+) or absence (FP) of a culprit lesion.
Results: Only Diaph was associated with increased likelihood of a Culprit lesion. Results were similar when analyzed by STE location (anterior, inferior, lateral); or by the 3 epicardial arteries (vessel analysis limited to Cul+ patients). Among Cul+, 809 had total occlusion (TO); 429 had incomplete occlusion (IO). There was no difference in the prevalence of NCP sx between Tot vs IO except for Diaph, which was more prevalent in TO (57.1%) vs IO (47.3%) or FP (30.1%; both p<0.001 vs TO). Among a subset of patients with STE but no chest pain (CP), NCP sx did not predict Cul+. In patients with no CP, there was a trend toward higher prevalence of Dysp in FP (45.9%) vs. Cul+ (32.2%) patients, suggesting that Dysp without CP triggered FP cath activation.
Conclusions: 1) In patients with suspected STEMI, Dysp, N/V, and Diz/Syn do not increase the likelihood of Cul+. 2) In contrast, Diaph significantly increases the likelihood of Cul+, as well as the likelihood that the Cul is TO. 3) In patients with STE but no chest pain, NCP sx should not be regarded as “chest pain equivalents.”
DOI
10.1016/j.jcin.2023.01.050
Publication Date
2-27-2023
Recommended Citation
Marc R. Antoine, Philip Salen, Jill Stoltzfus, Melinda Shoemaker, Peter R. Puleo, CRT-100.49 Diaphoresis, but Not Dyspnea, Nausea, or Dizziness, Is Associated With Finding a Culprit Lesion in Patients With Suspected ST Elevation Infarction, JACC: Cardiovascular Interventions, Volume 16, Issue 4, Supplement, 2023, Page S10, ISSN 1936-8798, https://doi.org/10.1016/j.jcin.2023.01.050. (https://www.sciencedirect.com/science/article/pii/S1936879823000511)