Candidates for thrombolysis among emergency room patients with acute chest pain. Potential true- and false-positive rates

STUDY OBJECTIVE: To assess the potential clinical impact of thrombolytic therapy for acute myocardial infarction by determining true-positive and false-positive rates of criteria for eligibility among emergency room patients with acute chest pain. DESIGN: Prospective multicenter cohort study. SETTING: Emergency rooms of three university and four community hospitals. PATIENTS: Emergency room patients (7734) with acute chest pain. MEASUREMENTS AND MAIN RESULTS: Only 261 (23%) of 1118 patients with acute myocardial infarctions were 75 years of age or younger, presented within 4 hours of the onset of pain, and had emergency room electrocardiograms showing probable acute myocardial infarction: 60 (0.9%) of the 6616 patients without infarction also met these criteria (positive predictive value, 261/321 = 81%; CI, 77% to 86%). The positive predictive value could increase to about 88% (CI, 82% to 93%) if eligibility were based on the official hospital electrocardiogram reading. CONCLUSIONS: Because experience from published studies suggests that about one third of patients who meet these three eligibility criteria have other contraindications to thrombolysis, we estimate that about 15% of patients with acute myocardial infarction would meet the criteria for eligibility for thrombolysis that have been used in clinical trials at the time of emergency room presentation. Further, for every eight patients with true-positive results who are treated, one to two patients with false-positive results may also be treated if decisions are based on the interpretation of a single electrocardiogram.