Abstract 12834: Cardiac Catheterization Lab Activations for ST-Segment Elevation Myocardial Infarction (STEMI) are Frequently Cancelled at a Major Los Angeles County STEMI-Receiving Center
Introduction: Los Angeles County (LAC) has developed ST-elevation myocardial infarction (STEMI)-receiving centers (SRC) which integrate pre-hospital electrocardiograms (PHECG) into a cardiac catheterization laboratory (CCL) activation algorithm as a strategy to reduce door-to-balloon (DTB) times. While DTB times have improved, CCL cancellations have become a challenging problem. We report the frequency and reasons for cancellation at a major LAC SRC.
Methods: We reviewed 1275 consecutive PHECG STEMI-activations between 1/1/2007 and 12/31/2012.
Results: Of the 1275 patients, 392 (31%) PHECG-activations were taken emergently to the CCL while 883 (69%) were cancelled. Reasons for cancellation (Figure 1) included poor-quality PHECG (n = 293, 23%), non-STEMI ST-segment abnormality (n = 123, 9.6%), dysrhythmia (n = 105, 8.2%), bundle-branch block (n = 96, 7.5%), early repolarization abnormality (n = 57, 4.5%), medical condition other than STEMI (n = 31, 2.4%), paced rhythm (n = 27, 2.1%), patient preference or goals of care (n = 22, 1.7%), and pericarditis (n = 14, 1.1%).
Conclusion: PHECG STEMI-activations were frequently cancelled at this Los Angeles SRC. This was most commonly attributable to a poor-quality PHECG. Further investigation is warranted to determine the clinical characteristics of patients who are taken to the CCL and those who are cancelled, as well as to determine the clinical outcomes for the various groups.
Author Disclosures: D. Lange: None. S. Conte: None. E. Pappas-Block: None. M. Nakamura: None. H. Jilaihawi: None. R. Makkar: None. S. Kar: None. T. Henry: None.
- © 2014 by American Heart Association, Inc.