"False-positive" cardiac catheterization laboratory activation among patients with suspected ST-segment elevation...

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.