"False-positive" cardiac catheterization laboratory activation among patients with suspected ST-segment elevation
David M Larson1, Katie M Menssen, Scott W Sharkey
1Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota 55407, USA.
Insights
False-positive cardiac catheterization laboratory activation for ST-segment elevation myocardial infarction (STEMI) is common. This highlights the need to balance rapid treatment with accurate diagnosis in suspected STEMI cases.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- Direct activation of the cardiac catheterization laboratory by emergency physicians is crucial for reducing door-to-balloon times in ST-segment elevation myocardial infarction (STEMI).
- Limited data exist on the frequency and implications of false-positive catheterization laboratory activations for suspected STEMI.
- Optimizing STEMI protocols requires understanding the rate of unnecessary procedures.
Purpose of the Study:
- To determine the prevalence of false-positive cardiac catheterization laboratory activations in patients with suspected STEMI.
- To investigate the underlying causes (etiology) of these false-positive activations.
- To evaluate the clinical outcomes associated with false-positive activations.
Main Methods:
- A prospective registry study was conducted within a regional healthcare system in Minnesota.
- Patients with suspected STEMI undergoing percutaneous coronary intervention at a tertiary cardiovascular center were enrolled.
- Data were collected from March 2003 to November 2006, including 1345 initially enrolled patients.
Main Results:
- Among 1335 patients undergoing angiography for suspected STEMI, 14% had no culprit coronary artery.
- 9.5% lacked significant coronary artery disease, and 11.2% had negative cardiac biomarkers.
- A combination of no culprit artery and negative biomarkers occurred in 9.2% of patients.
Conclusions:
- False-positive cardiac catheterization laboratory activations for suspected STEMI are relatively common in community settings.
- The definition of 'false-positive' influences the observed frequency.
- Current efforts to shorten STEMI door-to-balloon times should also address the consequences of unnecessary catheterization laboratory activations.
Context:
Allowing the emergency department physician to activate the cardiac catheterization laboratory is a key strategy to reduce door-to-balloon times in patients with ST-segment elevation myocardial infarction (STEMI). There are limited data on the frequency of "false-positive" catheterization laboratory activation in patients undergoing percutaneous coronary intervention for suspected STEMI.
Objective:
To determine the prevalence, etiology, and outcomes of false-positive cardiac catheterization laboratory activation in patients with a suspected STEMI.
Design, Setting, And Patients:
Prospective registry from a regional system that includes transfer of patients with STEMI from 30 community and rural hospitals with pretransfer catheterization laboratory activation for percutaneous coronary intervention at a tertiary cardiovascular center in Minnesota. A total of 1345 patients were enrolled from March 2003 to November 2006.
Main Outcome Measure:
Prevalence of false-positive catheterization laboratory activation in patients with suspected STEMI by 3 criteria: no culprit coronary artery, no significant coronary artery disease, and negative cardiac biomarker results.
Results:
Of the 1335 patients with suspected STEMI who underwent angiography, 187 (14%; 95% confidence interval [CI], 12.2%-16.0%) had no culprit coronary artery and 127 (9.5%; 95% CI, 8.0%-11.2%) did not have significant coronary artery disease. Cardiac biomarker levels were negative in 11.2% (95% CI, 9.6%-13.0%) of patients. The combination of no culprit artery with negative cardiac biomarker results was present in 9.2% (95% CI, 7.7%-10.9%) of patients. Thirty-day mortality was 2.7% (95% CI, 0.4%-5.0%) without vs 4.6% (95% CI, 3.4%-5.8%) with a culprit coronary artery (P = .33).
Conclusions:
The frequency of false-positive cardiac catheterization laboratory activation for suspected STEMI is relatively common in community practice, depending on the definition of false-positive. Recent emphasis on rapid door-to-balloon times must also consider the consequences of false-positive catheterization laboratory activation.
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