PURPOSE:The electrocardiographic (ECG) diagnosis of STEMI (ST-segment elevation myocardial infarction) is a relatively common finding in intensive care unit (ICU) patients. Several isolated case reports have described ICU patients exhibiting ECG evidence of STEMI that were attributed to other medical conditions. Our goal was to systematically collect STEMI ECGs in the ICU, and to correlate those to the presence of true myocardial infarctions.
METHODS:Using standard ECG interpretation software, ECGs indicating *** ST ELEVATION, ACUTE MI *** were systematically collected over a 15-month period. The STEMI ECG cases were compiled into a database which included pre-hospital and ICU characteristics, and mortality. The validity of the computer generated diagnosis was further evaluated by two cardiologists, and by serum troponins. Patients without concomitant serum troponin measurements were excluded.
RESULTS:Overall, 50 STEMI ECGs were collected from ICU patients. There was agreement with the computer interpretation in 42% (21/50) of cases after expert evaluation by two, board certified cardiologists. In only 16% (8/50) of cases there was a significant rise (≥5 mg/dL) in the serum troponin level. There were no statistically significant differences between the groups of patients, with or without elevated troponins, with regard to prehospital demographics, ICU complexity (use of pressors, inotropes, ventilatory status, dialysis), laboratory findings (electrolytes, complete blood counts), or ICU mortality.
CONCLUSION:Whether diagnosed by computer interpretation software or by expert evaluation, the ECG diagnosis of STEMI is relatively common in the ICU setting. Our results suggest that the vast majority of such patients do not have frank STEMI.
CLINICAL IMPLICATIONS:STEMI in the ICU is a relatively common ECG reading by standard interpretation software. In contrast to non-ICU patients presenting with chest pain, however, this is a nonspecific finding in the ICU that is frequently due to a variety of nonischemic processes.
DISCLOSURE:Stephen Rennyson, No Financial Disclosure Information; No Product/Research Disclosure Information