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False activation of the cardiac catheterization laboratory for primary PCI
Geoffery D Barnes1, Alexander Katz, Jeffrey S Desmond
1CVC Cardiovascular Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5853.
Insights
Reducing door-to-balloon times for ST-elevation myocardial infarction (STEMI) patients increased false cardiac catheterization lab activations. This trend highlights a potential trade-off between rapid treatment and efficient healthcare resource use in STEMI care.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Emergency Medicine
Background:
- National initiatives aim to reduce door-to-balloon (D2B) times for primary percutaneous coronary intervention (P-PCI) in ST-elevation myocardial infarction (STEMI) patients.
- Focusing on D2B times may inadvertently increase false cardiac catheterization laboratory (CCL) activations.
- This can lead to unnecessary healthcare utilization and resource strain.
Purpose of the Study:
- To evaluate trends in D2B times for STEMI patients.
- To assess changes in false CCL activation rates between 2007 and 2011.
- To understand the relationship between reduced D2B times and false activations.
Main Methods:
- Retrospective quality improvement chart review.
- Analysis of emergent CCL activations for P-PCI from 2007-2011.
- Determination of pre-hospital and ED false activation rates and median D2B times.
Main Results:
- CCL activations for suspected STEMI increased from 96 (2007) to 190 (2011).
- False CCL activations rose from 15% (2007) to 40% (2011).
- Median D2B time decreased from 67 to 55 minutes during the study period.
Conclusions:
- A 5-year focus on reducing D2B times correlated with an increased rate of false CCL activations for P-PCI.
- This suggests a need to balance rapid STEMI treatment with efficient healthcare resource allocation.
- Further strategies may be needed to optimize CCL activation protocols.
Objectives:
We sought to evaluate trends in door-to-balloon (D2B) times and false activation rates for the cardiac catheterization laboratory (CCL) in patients presenting to the emergency department (ED) with acute ST-elevation myocardial infarction (STEMI). In patients with STEMI, national efforts have focused on reducing D2B times for primary percutaneous coronary intervention (P-PCI). This emphasis on time-to-treatment may increase the rate of false CCL activations and unnecessary healthcare utilization.
Study Design:
Retrospective quality improvement chart review.
Methods:
We examined all emergent CCL activations for P-PCI between 2007 and 2011 at the University of Michigan Hospital. False activation was defined as emergent CCL activation when the patient did not require CCL care or emergent cardiology evaluation in the ED. Pre-hospital or ED false activation rates and mean D2B time were retrospectively determined by chart review.
Results:
The CCL was activated 717 times for suspected STEMI. The number of CCL activations increased from 96 in 2007 to 190 in 2011. False CCL activations accounted for 28% of all prehospital and 29% of all ED activations. The false activation rate increased from 15% of all cases in 2007 to 40% of all cases in 2011. The median D2B time decreased from 67 minutes in 2007 to 55 minutes in 2011.
Conclusions:
Over a 5-year period with a strong emphasis on reducing D2B times, there has been an increased CCL false activation rate for P-PCI.
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