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Acute myocardial infarction in patients with syncope

Published online by Cambridge University Press:  21 May 2015

Daniel McDermott ,
James V. Quinn  and
Charles E. Murphy
Daniel McDermott*
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, Calif.
James V. Quinn
Affiliation:
Department of Emergency Medicine, Stanford University, Palo Alto, Calif.
Charles E. Murphy
Affiliation:
Department of Emergency Medicine, University of California, San Francisco, Calif.
*
Division of Emergency Medicine, Department of Medicine, University of California, San Francisco, 505 Parnassus Ave., Box 0208, San Francisco CA 94143-0208; dmcderm@medicine.ucsf.edu

Abstract

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Objective:

We sought to determine the incidence of acute myocardial infarction (AMI) in emergency department (ED) patients with syncope, the characteristics of these AMIs and how helpful the initial electrocardiogram (ECG) was in identifying these cases.

Methods:

In a prospective cohort of consecutive patients with syncope, the initial ECG was found to be abnormal using a prespecified definition (any nonsinus rhythm or any new or age-indeterminate abnormalities). Patients were then followed up to identify an AMI diagnosed within 30 days of presentation.

Results:

There were 1474 consecutive patient visits for syncope or near-syncope over a 45-month period spanning from Jul. 1, 2000, to Feb. 28, 2002, and Jul. 15, 2002, to Aug. 31, 2004, of which 46 (3.1%) were diagnosed with AMI. The majority of the AMI patients (42) had no ST segment elevation. The initial ECG was abnormal in 37 out of 46 cases. The diagnostic performance of the initial ECG was sensitivity 80% (95% confidence interval [CI] 67%–89%), specificity 64% (95% CI 61%–67%), negative predictive value 99% (95% CI 98%–100%), positive predictive value 7% (95% CI 6%–8%), positive likelihood ratio 2.2 (95% CI 1.6–2.5) and negative likelihood ratio 0.3 (95% CI 0.2–0.5).

Conclusion:

The incidence of AMI in patients presenting with syncope is low. A normal ECG has a high negative predictive value, although its sensitivity is limited.

Keywords

syncopemyocardial infarctionelectrocardiogram
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 2 , March 2009 , pp. 156 - 160
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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