False ST-segment Elevation MI Score: A Simple Diagnostic Score to Predict False ST-segment Elevation MI Activation

Aim: Prompt evaluation is critical for patients with suspected acute ST-elevation MI (STEMI), although not all cases result in a confirmed diagnosis. This study aimed to develop a diagnostic score to predict false-positive STEMI activations. Methods: This is a cross-sectional observational study that includes patients consulted for acute STEMI via a mobile app. Multivariable logistic regression analysis identified independent predictors of false STEMI activation, which were used to create a diagnostic scoring system. Results: Among 301 patients, the incidence of false STEMI activation was 38.21%, with left ventricular hypertrophy being the most commonly misinterpreted presentation. Predictors of false activation included absence of typical chest pain (OR 260.73; 95% CI [37.36–1,819.48]), absence of reciprocal changes (OR 180.87; 95% CI [18.67–1,752.35]), and localised ST elevation within leads V1–V3 (OR 101.43; 95% CI [13.46–764.16]). A simple diagnostic score, called the false STEMI score, was developed by assigning 1 point for each predictor. Scores of 2 or more indicated a high likelihood of false STEMI activation. The score demonstrated excellent diagnostic performance, with an area under the receiver operating characteristic curve of 0.983, sensitivity of 96.5%, and specificity of 95.7%. Conclusion: A simple diagnostic score was developed to predict false STEMI activation effectively. Larger-scale validation studies are needed to confirm its reliability and evaluate its potential for reducing unnecessary STEMI activations in clinical practice.