Abstract 17753: Pre-Hospital and Emergency Department False-Positive Cardiac Catheterization Laboratory Activation among Patients with Suspected ST-Segment Elevation Myocardial Infarction: What is the "Cost of Doing Business"?
Objectives: Patients (pts) presenting with ST-elevation Myocardial Infarction (STEMI) represent a cardiovascular emergency. Low levels of false positive (FP) cardiac catheterization laboratory (CCL) activation are acceptable to maximize sensitivity, yet increased emphasis on reducing door to balloon time (D2B), including by EMS from the field, may increase the rate of FP CCL activation. We sought to investigate the trends in EMS and ED activations in relation to D2B time.
Methods: Consecutive CCL activations at our urban, academic, tertiary care hospital from June 2006-December 2011 were included. ED CCL activation independent of cardiology consultation was initiated in June 2006 and pre-hospital EMS activation in August 2007. Pts were excluded if they had cardiac arrest, were transferred from another hospital, or arrived by air EMS. FP CCL activation was defined as pts who had CCL cancelled after being initiated by the ED or EMS and also had MI excluded. In addition, the rate of FP coronary angiography (no significant disease and MI excluded) was determined.
Results: A total of 625 CCL activations were reviewed. D2B time decreased progressively from 76 to 59 minutes, with a substantial decrease when EMS pre-hospital activation was introduced (FIGURE). The rate of ED FP CLL activations (4.2-6.0%) and FP caths (11-18%) remained relatively constant over the study period. However, EMS FP CCL activations increased over time (1-14%) and accounted for >50% of FP CCL activations in 2011.
Conclusion: Reduced D2B times were associated with increased FP CCL activations, with a substantial contribution from EMS. Increased EMS education and/or transmission of ECGs may be helpful for reducing FP CCL activations.
- © 2012 by American Heart Association, Inc.