Abstract 18664: Rate of Accuracy in a System of Cath Lab Activation - The RASCAL Study
Primary PCI is the recommended treatment of choice for patients with STEMI. Treatment is based on ECG and symptoms alone why concern has been raised about overuse of invasive assessment. We designed this study to evaluate the accuracy of cath lab activation in a STEMI network with prehospital evaluation of ECG.
Method: We performed an analysis of the STEMI network in Östergötland County, Sweden, including two spoke hospitals and one hub hospital. Patients presenting with definitive or suspected MI either with direct admission to the cath lab or admitted to a CCU between December 1, 2009 and November 30, 2011 were included. Patients were identified in the Swedish National Quality Registry (SWEDEHEART), and we then reviewed medical records including ECG, cardiac enzyme levels and clinical assessment to decide if patients had a STEMI.
Results: Of 675 patients admitted directly to the cath lab, 554 were judged as STEMI resulting in a general accuracy of 82%. We then measured the accuracy for the different ways of arrival at the cath lab, resulting in 89% (355/399) for patients admitted from the ambulance, 74% (140/190) for patients admitted from emergency wards, and 69% (59/86) for patients admitted from any other hospital ward. Of all 652 patients judged as STEMI, 584 (90%) were either directly admitted to the cath lab or referred from the ambulance directly to the CCU of the hub hospital for clinical evaluation. The remaining group of 68 patients contained 22 patients presenting with symptom onset more than 12 hours before their first medical contact, and 26 patients with comorbidity as contraindication for primary PCI.
Conclusion: In our STEMI network we found a high rate of accuracy for cath lab activation at 82%, without reducing direct admittance of STEMI patients. High accuracy for cath lab activation with maintained high rate of direct admittance saves time, money and myocardium.
- © 2013 by American Heart Association, Inc.