Electrocardiograhic findings resulting in inappropriate cardiac catheterization laboratory activation for ST-segment
Shariq Shamim1, Justin McCrary1, Lori Wayne1
11 Cardiology Fellow University of Missouri, Kansas City, USA ; 2 Quality Improvement Director, Cardiology Section Truman Medical Center, USA ; 3 Professor and Chief of the Emergency Department University of Missouri, Kansas City and Truman Medical Center, USA ; 4 Formerly Associate Professor of Medicine University of Missouri, Kansas City and Chief of Cardiology of Truman Medical Center (Retired), USA.
Insights
Misinterpreting electrocardiograms (ECGs) led to nearly half of inappropriate ST-segment elevation myocardial infarction (STEMI) activations. This issue was common in African Americans with left ventricular hypertrophy.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Diagnostics
Background:
- Prompt reperfusion is crucial for ST-segment elevation myocardial infarction (STEMI) outcomes, necessitating a coordinated care approach.
- The rapid nature of STEMI protocols can lead to unnecessary cardiac catheterization laboratory (CCL) activations.
- Misinterpretation of electrocardiograms (ECGs) is a significant factor contributing to inappropriate CCL activations.
Purpose of the Study:
- To analyze electrocardiogram (ECG) findings associated with cardiac catheterization laboratory (CCL) activations.
- To identify the causes of inappropriate STEMI activations.
- To investigate demographic factors influencing ECG interpretation in acute chest pain patients.
Main Methods:
- Prospective observational study over 18 months.
- Collected data on all CCL activations.
- Reviewed ECG findings and final diagnoses for each activation.
Main Results:
- 139 CCL activations occurred; 77 confirmed STEMI, 62 were inappropriate.
- Nearly half (45%) of inappropriate activations stemmed from misinterpreting anterior ST-segment elevation on ECG.
- Electrocardiographic abnormalities were particularly challenging in African Americans with left ventricular hypertrophy.
Conclusions:
- Misinterpretation of anterior ST-segment elevation on ECG is a primary driver of inappropriate STEMI activations.
- This diagnostic challenge is frequently observed in African American patients with left ventricular hypertrophy.
- Improving ECG interpretation protocols can reduce unnecessary cardiac catheterization procedures.
Background:
Prompt reperfusion has been shown to improve outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with a goal of culprit vessel patency in <90 minutes. This requires a coordinated approach between the emergency medical services (EMS), emergency department (ED) and interventional cardiology. The urgency of this process can contribute to inappropriate cardiac catheterization laboratory (CCL) activations.
Objectives:
One of the major determinants of inappropriate activations has been misinterpretation of the electrocardiogram (ECG) in the patient with acute chest pain.
Methods:
We report the ECG findings for all CCL activations over an 18-month period after the inception of a STEMI program at our institution.
Results:
There were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation. The electrocardiographic abnormalities were particularly problematic in African-Americans with left ventricular hypertrophy.
Conclusions:
In this single-center, prospective observational study, nearly half of the inappropriate STEMI activations were due to the misinterpretation of anterior ST-segment elevation and this finding was commonly seen in African-Americans with left ventricular hypertrophy.
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