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Misdiagnosis of Acute Myocardial Infarction: A Systematic Review of the Literature

Kwok, Chun Shing; Bennett, Sadie; Azam, Ziyad; Welsh, Victoria; Potluri, Rahul; Loke, Yoon K.; Mallen, Christian D.

Authors

Chun Shing Kwok

Sadie Bennett

Ziyad Azam

Rahul Potluri

Yoon K. Loke



Abstract

Background: Despite the availability of tests to diagnose acute myocardial infarction (AMI), cases are still missed. Methods: We systematically reviewed the literature to determine how missed AMI has been defined, the reported rates of misdiagnosed AMI, the outcomes patients with misdiagnosed AMI have, what diagnosis was initially suspected in missed AMI cases, and what factors are associated with misdiagnosed AMI. We searched MEDLINE and EMBASE in September 2020 for studies that evaluated missed AMI. Data were extracted from studies that met the inclusion criteria and the results were narratively synthesized. Results: A total of 15 studies were included in this review. The number of patients with missed AMI in individual studies ranged from 64 to 4707. There was no consistently used definition for misdiagnosed AMI, but most studies reported rates of approximately 1%–2%. Compared with AMI that was recognized, 1 study found no difference in mortality for misdiagnosed AMI at 30 days and 1 year. The common initial misdiagnoses that subsequently had AMI were ischemic heart disease, nonspecific chest pain, gastrointestinal disease, musculoskeletal pain, and arrhythmias. Reasons for missed AMI include incorrect electrocardiogram interpretation and failure to order appropriate diagnostic tests. Hospitals in rural areas and those with a low proportion of classical chest pain patients that turned out to have AMI were at greater risk of missed AMI. Conclusions: Misdiagnosed AMI is an unfortunate part of everyday clinical practice and better training in electrocardiogram interpretation, and education about atypical presentations of AMI may reduce the number of misdiagnosed AMIs.

Journal Article Type Article
Acceptance Date Feb 17, 2021
Online Publication Date Feb 17, 2021
Publication Date Feb 17, 2021
Publicly Available Date Mar 28, 2024
Journal Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine
Print ISSN 1535-282X
Publisher Lippincott, Williams & Wilkins
Volume 20
Issue 3
Pages 155-162
DOI https://doi.org/10.1097/HPC.0000000000000256
Keywords Cardiology and Cardiovascular Medicine
Publisher URL https://doi.org/10.1097/HPC.0000000000000256